Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2740 | AZ |
NPI | 1376751396 |
---|---|
Provider Name | Ms. Linda Dale Korengold |
First Address | Florence, AZ 85232-7166 |
Second Address | Globe, AZ 85501-1436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |