Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC008121 | PA |
NPI | 1003182775 |
---|---|
Provider Name | Mr. Joshua Lowe |
First Address | Nanticoke, PA 18634-4207 |
Second Address | Nanticoke, PA 18634-4207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 28/03/2012 |