Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 0444 | SD |
NPI | 1003997982 |
---|---|
Provider Name | Jay Clayton |
First Address | Sioux Falls, SD 57105-2135 |
Second Address | Sioux Falls, SD 57105-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 15/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35144 | WELLMARK (01) | IA |