Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 0119006849 | VA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0119006849 | VA |
NPI | 1992212682 |
---|---|
Provider Name | Baron Gray Garner |
First Address | Lawrenceville, VA 23868-3709 |
Second Address | Tappahannock, VA 22560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2018 |
Last Update Date | 04/01/2018 |