Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 04509 | OH |
NPI | 1013278761 |
---|---|
Provider Name | Mr. George William Merkich JR. |
First Address | Chester, WV 26034-1217 |
Second Address | Chester, WV 26034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 30/05/2012 |