Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 00635 | IA |
NPI | 1013114396 |
---|---|
Provider Name | James Simmons |
First Address | Red Oak, IA 51566 |
Second Address | Red Oak, IA 51566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 08/07/2007 |