Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OC013934 | PA |
NPI | 1669829073 |
---|---|
Provider Name | Ashlee Ward |
First Address | Shavertown, PA 18708-9482 |
Second Address | Nanticoke, PA 18634-1327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2016 |
Last Update Date | 06/03/2019 |