Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.05764 | OH |
NPI | 1023424744 |
---|---|
Provider Name | Mr. Jarom A Boxx |
First Address | Springfield, OH 45502-8333 |
Second Address | Louisville, KY 40222-5158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 02/07/2014 |