Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0119005627 | VA |
NPI | 1265773832 |
---|---|
Provider Name | Marilyn Edmonds |
First Address | New Market, VA 22844-3103 |
Second Address | New Market, VA 22844-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2013 |
Last Update Date | 07/03/2013 |