Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1043757636 |
---|---|
Provider Name | Gary Spillane |
First Address | Keizer, OR 97303-4829 |
Second Address | Keizer, OR 97303-4829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2017 |
Last Update Date | 20/01/2017 |