Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5201006031 | MI |
NPI | 1073677357 |
---|---|
Provider Name | Mr. Anthony Jason Laforme |
First Address | Fort Knox, KY 40121-2168 |
Second Address | Fort Knox, KY 40121-5111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 01/05/2019 |