Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XE0001X | Environmental Modification | VA | |
Y | 225XG0600X | Occupational Therapist - Gerontology | 0119006380 | VA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | VA |
NPI | 1689210049 |
---|---|
Provider Name | Miss Sun Park |
First Address | Springfield, VA 22153-1938 |
Second Address | Alexandria, VA 22311-5069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2019 |
Last Update Date | 20/11/2019 |