Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0131001475 | VA |
NPI | 1003263286 |
---|---|
Provider Name | Mollie Kamerow |
First Address | Annandale, VA 22003-6006 |
Second Address | Annandale, VA 22003-6006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2016 |
Last Update Date | 18/05/2016 |