Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP005826 | PA |
NPI | 1033318241 |
---|---|
Provider Name | Mr. David Anthony Tyler SR. |
First Address | Limerick, PA 19468-4355 |
Second Address | Wexford, PA 15090-9260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 17/07/2007 |