Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1083021315 |
---|---|
Provider Name | Robert Stock |
First Address | Virginia Beach, VA 23454-4276 |
Second Address | Virginia Beach, VA 23454-4276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2014 |
Last Update Date | 18/07/2014 |