Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5810 | AZ |
NPI | 1023638202 |
---|---|
Provider Name | Jamie W Hyler |
First Address | Glendale, AZ 85303-2326 |
Second Address | Glendale, AZ 85303-2326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2020 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5810 | ARIZONA COTA LICENSE NUMBER (01) | AZ |