Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 008538 | OH |
NPI | 1457825614 |
---|---|
Provider Name | Mr. Deric Graft |
First Address | Knoxville, TN 37932-3347 |
Second Address | Columbus, OH 43215-1609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2019 |
Last Update Date | 21/01/2019 |