Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119005480 | VA |
NPI | 1003189184 |
---|---|
Provider Name | Lauren Delp |
First Address | Wirtz, VA 24184-4133 |
Second Address | Wirtz, VA 24184-4133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2012 |
Last Update Date | 20/06/2012 |