Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043658693 |
---|---|
Provider Name | Dean Michael Mccorkle |
First Address | Reno, NV 89509-4775 |
Second Address | Reno, NV 89509-4775 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2013 |
Last Update Date | 27/06/2014 |