Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119006638 | VA |
NPI | 1063887974 |
---|---|
Provider Name | Mrs. Renee Hartley |
First Address | Stafford, VA 22554-8508 |
Second Address | Stafford, VA 22554-8331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2015 |
Last Update Date | 03/12/2015 |