Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119007159 | VA |
NPI | 1003350992 |
---|---|
Provider Name | Sarah Carraway |
First Address | Fredericksburg, VA 22407-0141 |
Second Address | Fredericksburg, VA 22407-0141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2016 |
Last Update Date | 12/12/2016 |