Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1359 | WV |
NPI | 1730551003 |
---|---|
Provider Name | Brenda Hambric |
First Address | Crab Orchard, WV 25827-0336 |
Second Address | Crab Orchard, WV 25827-9655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2015 |
Last Update Date | 27/10/2015 |