Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT-4112 | OH |
N | 2251E1200X | Ergonomics | PT-4112 | OH |
N | 225XE1200X | Ergonomics | PT-4112 | OH |
N | 2251S0007X | Physical Therapist - Sports | PT-4112 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | PT-4112 | OH |
NPI | 1366498701 |
---|---|
Provider Name | Mrs. Deanna Marie Mccomish |
First Address | Holland, OH 43528-7974 |
Second Address | Holland, OH 43528-7974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2514747 | (05) | OH |