Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 60928738 | WA |
NPI | 1013571330 |
---|---|
Provider Name | Anna Marie Corey |
First Address | Buckley, WA 98321-9413 |
Second Address | Buckley, WA 98321-9413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2019 |
Last Update Date | 23/04/2019 |