Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 3271 | SC |
NPI | 1073859682 |
---|---|
Provider Name | Barry Clay Poole |
First Address | Seneca, SC 29672-0766 |
Second Address | Seneca, SC 29672-0766 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2012 |
Last Update Date | 31/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R35839 | (02) | CA |