Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 007423 | OH |
NPI | 1295082881 |
---|---|
Provider Name | Mary M. Phelan |
First Address | Milford, OH 45150-1521 |
Second Address | Norwood, OH 45212-2244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 14/08/2012 |