Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 10000804 | DC |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4402 | TN |
NPI | 1124383898 |
---|---|
Provider Name | Moses Osemwegie JR. |
First Address | Nashville, TN 37207-3648 |
Second Address | Washington, DC 20037-1008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 09/07/2012 |