Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1003261314 |
---|---|
Provider Name | Dillon Trumbo |
First Address | Wasilla, AK 99687-6104 |
Second Address | Wasilla, AK 99654-8075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2016 |
Last Update Date | 25/04/2016 |