Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0119004546 | VA |
NPI | 1114357324 |
---|---|
Provider Name | Nathan Pendell |
First Address | Fairfax, VA 22031-2504 |
Second Address | Fairfax, VA 22031-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 25/11/2013 |