Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | 0806 | AL |
Y | 225XG0600X | Occupational Therapist - Gerontology | 0806 | AL |
NPI | 1376864132 |
---|---|
Provider Name | Ms. Laurel Rico |
First Address | Scottsboro, AL 35769-3633 |
Second Address | Scottsboro, AL 35769-3633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2010 |
Last Update Date | 16/06/2010 |