Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA-046666 | AZ |
NPI | 1003382466 |
---|---|
Provider Name | Samantha Truscott |
First Address | Mesa, AZ 85206-2798 |
Second Address | Mesa, AZ 85206-2798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2018 |
Last Update Date | 23/10/2018 |