Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 962 | CA |
NPI | 1003156647 |
---|---|
Provider Name | Kevin Brewer |
First Address | Long Beach, CA 90803-5874 |
Second Address | Farmington Hills, MI 48331-5716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2013 |
Last Update Date | 19/02/2013 |