Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC002525L | PA |
Y | 225XH1200X | Occupational Therapist - Hand | OC002525L | PA |
NPI | 1174519656 |
---|---|
Provider Name | John Farabaugh |
First Address | Boston, MA 02284-8269 |
Second Address | Allentown, PA 18104-9168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03016201 | BLUE CROSS (01) | PA |
03016201 | KEYSTONE CENTRAL (01) | PA |