Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 01442 | OH |
NPI | 1023139524 |
---|---|
Provider Name | Mr. Max Contreras |
First Address | North Royalton, OH 44133-2130 |
Second Address | Louisville, KY 40202-2407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 22/08/2015 |