Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1013307321 |
---|---|
Provider Name | Angela Joiner |
First Address | Blytheville, AR 72315-8033 |
Second Address | Blytheville, AR 72315-8033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2015 |
Last Update Date | 26/01/2015 |