Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT1332 | MS |
NPI | 1518214634 |
---|---|
Provider Name | Mrs. Undrea Nash |
First Address | Byram, MS 39272-5604 |
Second Address | Yazoo City, MS 39194-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 08/08/2012 |