Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119006884 | VA |
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1295248458 |
---|---|
Provider Name | Cassandra Compton |
First Address | Pilot, VA 24138-1564 |
Second Address | Salem, VA 24153-1961 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2017 |
Last Update Date | 05/08/2021 |