Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 2444 | AZ |
NPI | 1093141012 |
---|---|
Provider Name | Erik Markoff |
First Address | Gilbert, AZ 85296-4799 |
Second Address | Tempe, AZ 85281-3143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
788440 | (05) | AZ |