Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1013432293 |
---|---|
Provider Name | Justin Silveira |
First Address | Scranton, AR 72863-9228 |
Second Address | Springdale, AR 72762-0985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2017 |
Last Update Date | 08/08/2017 |