Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4721 | MT |
NPI | 1659802668 |
---|---|
Provider Name | Miss Alexus Marie Cox |
First Address | Great Falls, MT 59405 |
Second Address | Great Falls, MT 59405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 25/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1659802668 | (05) | MT |