Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | C1553 | WV |
NPI | 1033278247 |
---|---|
Provider Name | Phillip Bartram |
First Address | Russell, KY 41169-1414 |
Second Address | Huntington, WV 25705-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |