Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 898 | AK |
N | 225XE0001X | Environmental Modification | 898 | AK |
N | 225XG0600X | Occupational Therapist - Gerontology | 898 | AK |
NPI | 1780912865 |
---|---|
Provider Name | Michele Nmn Champion |
First Address | Anchorage, AK 99503-1712 |
Second Address | Mc Lean, VA 22102-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2009 |
Last Update Date | 30/11/2009 |