Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP2217 |
NPI | 1407852023 |
---|---|
Provider Name | Mr. Adam John Lehotay |
First Address | Charleston, WV 25302-1801 |
Second Address | Charleston, WV 25302-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6301016000 | (05) | WV |