Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5145 | AL |
NPI | 1083241442 |
---|---|
Provider Name | Michael Alexander Pannell |
First Address | Tuscaloosa, AL 35406-2500 |
Second Address | Tuscaloosa, AL 35401-2009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2020 |
Last Update Date | 25/03/2020 |