Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 04571 | OH |
NPI | 1023417631 |
---|---|
Provider Name | Mrs. Maggie May Mason |
First Address | Troy, OH 45373-2718 |
Second Address | Troy, OH 45373-2718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2014 |
Last Update Date | 19/08/2014 |