Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2729 | WA |
NPI | 1174025571 |
---|---|
Provider Name | Tommy Hall |
First Address | Arlington, WA 98223-4503 |
Second Address | Arlington, WA 98223-4669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2018 |
Last Update Date | 02/03/2018 |