Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand |
NPI | 1093918757 |
---|---|
Provider Name | Mel Henderson |
First Address | Colorado Springs, CO 80907-4900 |
Second Address | Colorado Springs, CO 80907-4900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 08/07/2007 |