Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC004317L | PA |
NPI | 1023465721 |
---|---|
Provider Name | Virginia Robertson |
First Address | Hanover, PA 17331-8682 |
Second Address | Hanover, PA 17331-8682 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2016 |
Last Update Date | 23/05/2016 |