Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 010643 | OH |
NPI | 1063836914 |
---|---|
Provider Name | Amanda Tabellion |
First Address | Louisville, OH 44641-8317 |
Second Address | Louisville, OH 44641-8317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2014 |
Last Update Date | 13/02/2014 |