Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0131000112 | VA |
NPI | 1003155698 |
---|---|
Provider Name | Phillip Anthony House |
First Address | Roanoke, VA 24018-2840 |
Second Address | Roanoke, VA 24018-2840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2013 |
Last Update Date | 10/06/2016 |