Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 6949 | AZ |
NPI | 1013442912 |
---|---|
Provider Name | James Beck JR. |
First Address | Phoenix, AZ 85017-5904 |
Second Address | Phoenix, AZ 85017-5904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2017 |
Last Update Date | 28/04/2017 |