Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 4174 | AL |
N | 225XH1200X | Occupational Therapist - Hand | OT9768 | FL |
NPI | 1255864708 |
---|---|
Provider Name | Jeff R Hinson |
First Address | Columbus, GA 31909-3540 |
Second Address | Dothan, AL 36303-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 11/04/2017 |