Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2306602062 | VA |
NPI | 1033285325 |
---|---|
Provider Name | Ms. Edwina M Addison |
First Address | Charlottesville, WA 22903 |
Second Address | Roseland, VA 22967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |