Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2473 | NH |
NPI | 1003320425 |
---|---|
Provider Name | Miranda Sherburne |
First Address | Sandown, NH 03873-2410 |
Second Address | Manchester, NH 03101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2017 |
Last Update Date | 21/11/2017 |