Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA-2176 | OH |
NPI | 1023356862 |
---|---|
Provider Name | Mrs. Christine L Mcavinew |
First Address | Massillon, OH 44646-8822 |
Second Address | Massillon, OH 44646-8822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2013 |
Last Update Date | 30/01/2013 |