Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0131001128 | VA |
NPI | 1023451366 |
---|---|
Provider Name | Emil El-Ayazra |
First Address | Manassas, VA 20109-6462 |
Second Address | Manassas, VA 20109-6462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2013 |
Last Update Date | 16/04/2013 |