Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00003625 | WA |
NPI | 1003076225 |
---|---|
Provider Name | Mr. John D Ehlers |
First Address | Colville, WA 99114-5014 |
Second Address | Colville, WA 99114-5014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 11/06/2008 |