Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | WY | |
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1659858819 |
---|---|
Provider Name | Trevor Behler |
First Address | Slatington, PA 18080-2005 |
Second Address | Boise, ID 83712-6241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2018 |
Last Update Date | 07/08/2019 |