Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1225696784 |
---|---|
Provider Name | Tiffany Chen |
First Address | Fairfax, VA 22032-2442 |
Second Address | Fairfax, VA 22030-6904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2019 |
Last Update Date | 30/05/2019 |