Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT-1425 | WY |
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1366911257 |
---|---|
Provider Name | Jared Pulliam |
First Address | Westerville, OH 43081-3777 |
Second Address | Rawlins, WY 82301-5241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2018 |
Last Update Date | 18/07/2019 |