Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2862 | AK |
NPI | 1912388273 |
---|---|
Provider Name | Tyler Dinnan |
First Address | Soldotna, AK 99669-7658 |
Second Address | Soldotna, AK 99669-7658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2015 |
Last Update Date | 12/06/2015 |