Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 207173 | TX |
NPI | 1154716348 |
---|---|
Provider Name | Darwin Kurth |
First Address | Crossville, TN 38555-6120 |
Second Address | Crossville, TN 38555-6120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 03/04/2015 |