Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119006585 | VA |
NPI | 1003285735 |
---|---|
Provider Name | Mrs. Ashley Fariss Stewart |
First Address | Richmond, VA 23230-2912 |
Second Address | Richmond, VA 23230-2912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2015 |
Last Update Date | 23/09/2015 |