Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1003394867 |
---|---|
Provider Name | Katelin B Clifton |
First Address | Martinsville, VA 24112-3700 |
Second Address | Martinsville, VA 24112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2018 |
Last Update Date | 03/08/2018 |