Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 3423 | AL |
NPI | 1013280064 |
---|---|
Provider Name | Miss Amy Cannon |
First Address | Mobile, AL 36609 |
Second Address | Mobile, AL 36609-5143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 21/02/2012 |