Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA. 04260 | OH |
NPI | 1003150517 |
---|---|
Provider Name | Heather M Trumbull |
First Address | North Canton, OH 44720-2593 |
Second Address | North Canton, OH 44720-2593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2012 |
Last Update Date | 21/11/2012 |