Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP001867L | PA |
NPI | 1013115716 |
---|---|
Provider Name | Mr. Edward Leo Rising |
First Address | Mount Bethel, PA 18343-5514 |
Second Address | Bangor, PA 18013-9341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 08/07/2007 |