Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119003289 | VA |
NPI | 1003948258 |
---|---|
Provider Name | Alice Blair |
First Address | Fairfax, VA 22031-3752 |
Second Address | Fairfax, VA 22031-3752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |