Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | U2-0001701 | DE |
NPI | 1003367020 |
---|---|
Provider Name | Alexis Graham |
First Address | New Castle, DE 19720-1383 |
Second Address | New Castle, DE 19720-1383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2016 |
Last Update Date | 14/10/2016 |