Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | R5000 | KY |
NPI | 1073885760 |
---|---|
Provider Name | Mr. John Michael Gay JR. |
First Address | Corydon, IN 47112-1817 |
Second Address | New Albany, IN 47150-9426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2012 |
Last Update Date | 25/01/2016 |