Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OTR009268 | OH |
NPI | 1174069827 |
---|---|
Provider Name | Tyler A Ganelli |
First Address | Beachwood, OH 44122-6054 |
Second Address | Beachwood, OH 44122-6054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2017 |
Last Update Date | 18/01/2017 |