Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0119006543 | VA |
NPI | 1477042984 |
---|---|
Provider Name | Ana Teresa Mebune |
First Address | Woodbridge, VA 22191-5502 |
Second Address | Woodbridge, VA 22191-5502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 10/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | N/A (01) |