Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119003394 | VA |
NPI | 1003898586 |
---|---|
Provider Name | Mr. Mark O Okafor |
First Address | Stanleytown, VA 24168-3014 |
Second Address | Stanleytown, VA 24168-3014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 11/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
743117794 | MEDRISK (01) | VA |
743117794 | TRICARE (01) | VA |