Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 009201 | OH |
NPI | 1003325036 |
---|---|
Provider Name | Elizabeth Dubois |
First Address | Lakewood, OH 44107-2169 |
Second Address | Cleveland, OH 44134-6743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 21/09/2017 |