Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT 375 | WA |
NPI | 1265481345 |
---|---|
Provider Name | Mr. Clark Dana Battan |
First Address | Spokane, WA 99208-9472 |
Second Address | Spokane, WA 99202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |