Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 148350 | AK |
NPI | 1003475559 |
---|---|
Provider Name | Eva Cress Lyons |
First Address | Anchorage, AK 99508-5234 |
Second Address | Anchorage, AK 99508-5234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2019 |
Last Update Date | 20/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1697575 | (05) | AK |