Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119008390 | VA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 0119008390 | VA |
NPI | 1013552264 |
---|---|
Provider Name | Zachariah Scott Class |
First Address | Alexandria, KY 41001-7925 |
Second Address | Portsmouth, VA 23707-4630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2019 |
Last Update Date | 12/11/2019 |