Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1003456799 |
---|---|
Provider Name | Ms. Beverly Pray |
First Address | Spokane, WA 99205-1326 |
Second Address | Caldwell, ID 83605-5425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2020 |
Last Update Date | 09/01/2020 |