Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1532 | OK |
NPI | 1023625050 |
---|---|
Provider Name | Shelby Daniel |
First Address | Altus, OK 73521-6192 |
Second Address | Altus, OK 73521-6192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2020 |
Last Update Date | 24/09/2020 |