Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1719 | AL |
NPI | 1285841023 |
---|---|
Provider Name | Tg Tregre |
First Address | Daphne, AL 36526-8116 |
Second Address | Foley, AL 36535-8970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |