Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT 60341656 | WA |
NPI | 1134555709 |
---|---|
Provider Name | Mr. Samuel Robert Brune |
First Address | Spokane, WA 99202-1426 |
Second Address | Spokane, WA 99202-1426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2013 |
Last Update Date | 16/09/2013 |