Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.05487 | OH |
NPI | 1023418142 |
---|---|
Provider Name | Miss Samantha L Henderson |
First Address | Massillon, OH 44646-4526 |
Second Address | Canton, OH 44707-3625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 26/08/2014 |