Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 7219 | NC |
Y | 224Z00000X | Occupational Therapy Assistant | C1614 | WV |
NPI | 1003168766 |
---|---|
Provider Name | Mrs. Shadonda Evette Briggs |
First Address | Beckley, WV 25801-3928 |
Second Address | Beckley, WV 25801-3928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2012 |
Last Update Date | 04/10/2012 |