Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119007251 | VA |
NPI | 1023558806 |
---|---|
Provider Name | Miranda Showalter |
First Address | Danville, VA 24540-2863 |
Second Address | Danville, VA 24540-2863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2017 |
Last Update Date | 28/02/2017 |