Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | A02647 | MD |
NPI | 1003469388 |
---|---|
Provider Name | Luis Fernando Mejia |
First Address | Glen Burnie, MD 21060-7060 |
Second Address | Glen Burnie, MD 21060-7060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2019 |
Last Update Date | 16/07/2019 |