Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC010250 | PA |
NPI | 1003174616 |
---|---|
Provider Name | June Terrell |
First Address | Philadelphia, PA 19119-1532 |
Second Address | Philadelphia, PA 19119-1532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 02/05/2012 |