Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 241279 | KY |
NPI | 1093203200 |
---|---|
Provider Name | Christopher Dunn |
First Address | Grayson, KY 41143-1603 |
Second Address | Grayson, KY 41143-1603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 24/04/2018 |