Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5922 | AZ |
NPI | 1013423151 |
---|---|
Provider Name | Adria Rene Cory |
First Address | Phoenix, AZ 85043-1917 |
Second Address | Phoenix, AZ 85043-1917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2017 |
Last Update Date | 27/12/2017 |