Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 134230 | KY |
NPI | 1184619280 |
---|---|
Provider Name | Mr. Ryan David Foister |
First Address | Lexington, KY 40504-2930 |
Second Address | Lexington, KY 40504-2930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 16/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100445120 | (05) | KY |