Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0119-007946 | VA |
NPI | 1134690647 |
---|---|
Provider Name | Mr. Miles Viant |
First Address | New Milford, NJ 07646-2629 |
Second Address | Petersburg, VA 23805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 10/12/2018 |