Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC010241 | PA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT008697 | OH |
NPI | 1063530608 |
---|---|
Provider Name | Miss Michele Louise Dunham |
First Address | Youngstown, OH 44511-3635 |
Second Address | New Castle, PA 16105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1017855780001 | MEDICAL ASSISTANCE # (01) | PA |