Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119005395 | VA |
NPI | 1003194119 |
---|---|
Provider Name | Tyler Schorr |
First Address | Fairfax, VA 22031-4214 |
Second Address | Springfield, VA 22151-3933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 25/07/2011 |