Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1998 | AL |
NPI | 1033380191 |
---|---|
Provider Name | Ms. Keyna Nicole Smith |
First Address | Russellville, AL 35653-1358 |
Second Address | Russellville, AL 35653-1358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2008 |
Last Update Date | 17/03/2008 |