Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner |
NPI | 1841590866 |
---|---|
Provider Name | Mr. Tracy Cameron Mansfield |
First Address | Eugene, OR 97401-8507 |
Second Address | Eugene, OR 97401-8507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2010 |
Last Update Date | 01/11/2015 |