Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.06430 | OH |
NPI | 1003395476 |
---|---|
Provider Name | Mrs. Lori Mowery |
First Address | Massillon, OH 44646-4900 |
Second Address | Mogadore, OH 44260-9577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2018 |
Last Update Date | 07/08/2018 |