Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1255713970 |
---|---|
Provider Name | Mrs. Brian Johnson |
First Address | Claremont, NH 03743-2720 |
Second Address | Claremont, NH 03743-2720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 19/06/2015 |