Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 342834 | AZ |
N | 225XE0001X | Environmental Modification | 342834 | AZ |
N | 2251E1200X | Ergonomics | 342834 | AZ |
N | 225XE1200X | Ergonomics | 342834 | AZ |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 342834 | AZ |
NPI | 1326604083 |
---|---|
Provider Name | Madison Driggs Flake |
First Address | Queen Creek, AZ 85142-9686 |
Second Address | Queen Creek, AZ 85142-9686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2019 |
Last Update Date | 17/05/2019 |