Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OC-005000L | PA |
NPI | 1801936778 |
---|---|
Provider Name | Mr. Christian Travis Parker |
First Address | Arendtsville, PA 17303-0207 |
Second Address | Chambersburg, PA 17201-1720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |