Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 13036 | MA |
NPI | 1396201042 |
---|---|
Provider Name | Omadevi Dhanraj |
First Address | Salem, NH 03079-4804 |
Second Address | Amesbury, MA 01913-2119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2019 |
Last Update Date | 19/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13036 | PROFESSIONAL LICENSE (01) | MA |