Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 004580 | MO |
NPI | 1174653489 |
---|---|
Provider Name | Mr. David Levy |
First Address | Hazelwood, MO 63042-1739 |
Second Address | Hazelwood, MO 63042-1739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |