Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA2029 | OH |
NPI | 1013167790 |
---|---|
Provider Name | Stacey Biddle |
First Address | Painesville, OH 44077-1616 |
Second Address | Painesville, OH 44077-1616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 30/09/2008 |