Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1203 | NE |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 133840 | KY |
NPI | 1770515611 |
---|---|
Provider Name | Mr. Mark Showers |
First Address | Fort Campbell, KY 42223-5318 |
Second Address | Fort Campbell, KY 42223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 15/02/2019 |