Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner | RESNA | |
Y | 225X00000X | Occupational Therapist | 0119003829 | VA |
NPI | 1477725265 |
---|---|
Provider Name | Sue Hossack |
First Address | Blacksburg, VA 24060-8678 |
Second Address | Blacksburg, VA 24060-8678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2008 |
Last Update Date | 12/12/2011 |