Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2742 | AK |
NPI | 1003233750 |
---|---|
Provider Name | Emily Ireland |
First Address | Eagle River, AK 99577-7798 |
Second Address | Eagle River, AK 99577-7558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2014 |
Last Update Date | 28/01/2019 |