Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1366952038 |
---|---|
Provider Name | Christy Rae Vineberg |
First Address | Lafayette Hill, PA 19444-1409 |
Second Address | Greenville, SC 29615-1969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2017 |
Last Update Date | 06/10/2017 |