Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1276 | WV |
NPI | 1104155811 |
---|---|
Provider Name | Mrs. Amy Ellen Lawrence |
First Address | South Charleston, WV 25309-2417 |
Second Address | Charleston, WV 25313-1467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2009 |
Last Update Date | 09/12/2009 |