Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0000001185 | TN |
NPI | 1023209103 |
---|---|
Provider Name | Mr. Jonathan Wash |
First Address | Chattanooga, TN 37403-1306 |
Second Address | Chattanooga, TN 37403-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 05/08/2007 |