Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 898 | WV |
NPI | 1003865668 |
---|---|
Provider Name | Mrs. Allison Beth Venable |
First Address | Beckley, WV 25801-2308 |
Second Address | Beckley, WV 25801-6444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
898 | WV OT LICENSE (01) | WV |