Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1073061727 |
---|---|
Provider Name | Patricia Wilkins |
First Address | Charlottesville, VA 22903-5128 |
Second Address | Charlottesville, VA 22903-5128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2016 |
Last Update Date | 12/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
365223 | NBCOT BOARD CERTIFICATION (01) |