Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 09075 | MD |
NPI | 1003421777 |
---|---|
Provider Name | Savanna Ivill |
First Address | Cherry Hill, NJ 08003-1000 |
Second Address | Baltimore, MD 21212-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |