Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1205400223 |
---|---|
Provider Name | Courtney Wood |
First Address | Allentown, PA 18104-2310 |
Second Address | Allentown, PA 18104-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2021 |
Last Update Date | 02/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OC016753 | STATE LICENSE (01) | PA |