Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003332388 |
---|---|
Provider Name | Alexa Archambeault |
First Address | Bowie, MD 20715-1715 |
Second Address | Bowie, MD 20715-1715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2017 |
Last Update Date | 17/08/2017 |