Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4050 | TN |
NPI | 1023635539 |
---|---|
Provider Name | Mrs. Virginia Roberts |
First Address | Arlington, TN 38002-5922 |
Second Address | Arlington, TN 38002-5922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 30/06/2020 |