Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | T-OTA.0000024 | CO |
NPI | 1023628765 |
---|---|
Provider Name | Ryan James Sumsion |
First Address | Pueblo, CO 81005-3319 |
Second Address | Pueblo, CO 81008-4101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2020 |
Last Update Date | 07/08/2020 |