Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT1323 | AR |
NPI | 1508496019 |
---|---|
Provider Name | Alan Glenn Daugherty |
First Address | Hot Springs, AR 71913-2516 |
Second Address | Arkadelphia, AR 71923-4211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 23/01/2020 |