Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 0119002503 | VA |
NPI | 1114320884 |
---|---|
Provider Name | Stephanie Williams |
First Address | Independence, VA 24348-3879 |
Second Address | Independence, VA 24348-3879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2014 |
Last Update Date | 08/10/2014 |