Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2043 | NM |
NPI | 1023457694 |
---|---|
Provider Name | Mr. David Harry Schultz |
First Address | Silver City, NM 88061-7876 |
Second Address | Truth Or Consequences, NM 87901-1957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 17/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
224Z00000X | (05) | NM |