Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | PT1480 | MS |
NPI | 1003842758 |
---|---|
Provider Name | Gabrielle Chiniche |
First Address | Columbus, MS 39705-2024 |
Second Address | Oxford, MS 38655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 28/03/2019 |