Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4269 | AL |
N | 225XH1200X | Occupational Therapist - Hand | OT3164 | MS |
NPI | 1215383617 |
---|---|
Provider Name | Zachary Blake Houle |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604-1512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 21/02/2017 |