Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA007896 | OH |
NPI | 1013585603 |
---|---|
Provider Name | Mindy Lynn Debord |
First Address | Reynoldsburg, OH 43068-7072 |
Second Address | Reynoldsburg, OH 43068-7072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 11/06/2021 |