Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 12627 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 6690 | TN |
NPI | 1053654855 |
---|---|
Provider Name | Emily Siren Medina |
First Address | Nashville, TN 37220-1307 |
Second Address | Nashville, TN 37220-1307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2013 |
Last Update Date | 25/02/2021 |