Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1543 | SC |
NPI | 1427632504 |
---|---|
Provider Name | Virginia Dodd Vanzant |
First Address | Johnston, SC 29832-2660 |
Second Address | Johnston, SC 29832-2660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2021 |
Last Update Date | 05/05/2021 |