Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 917 | TN |
N | 225XG0600X | Occupational Therapist - Gerontology | 917 | TN |
NPI | 1770897894 |
---|---|
Provider Name | Mr. Thomas J Trinidad |
First Address | Jackson, TN 38305-8778 |
Second Address | Humboldt, TN 38343-3036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2010 |
Last Update Date | 30/07/2010 |