Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT1016 | WV |
NPI | 1679122873 |
---|---|
Provider Name | Robert William Alford |
First Address | Huntington, WV 25701-4235 |
Second Address | Huntington, WV 25701-4235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2019 |
Last Update Date | 10/09/2019 |