Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5710 | NC |
NPI | 1003913708 |
---|---|
Provider Name | Dr. Brian Tuan Gregg |
First Address | Fort Benning, GA 31905-5647 |
Second Address | Fort Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 05/11/2020 |