Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0644 | NH |
NPI | 1003169970 |
---|---|
Provider Name | Mr. Ryan Allan Kemp |
First Address | Madison, ME 04950 |
Second Address | Bedford, NH 03110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2012 |
Last Update Date | 17/10/2012 |