Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2411 | TN |
NPI | 1013441120 |
---|---|
Provider Name | Anissa Wanamaker |
First Address | Smithville, TN 37166-2140 |
Second Address | Smithville, TN 37166-2140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2017 |
Last Update Date | 14/04/2017 |