Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 03452 | OH |
NPI | 1033315445 |
---|---|
Provider Name | Mr. Alex Alden Saunders |
First Address | Gallipolis, OH 45631-9418 |
Second Address | Pomeroy, OH 45769-9730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0410817 | (05) | OH |