Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA 428 | OH |
NPI | 1013312909 |
---|---|
Provider Name | Farzaneh Mader |
First Address | Yellow Springs, OH 45387-1239 |
Second Address | Springfield, OH 45506-2278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 04/11/2014 |