Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119008205 | VA |
NPI | 1003476755 |
---|---|
Provider Name | Karly Thompson |
First Address | Cherry Hill, NJ 08003-1000 |
Second Address | Winchester, VA 22601-4869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2019 |
Last Update Date | 15/06/2019 |