Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Physical Rehabilitation |
225XP0019X | 67 | Occupational Therapist in Private Practice |
| NPI # | 1124475132 |
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| LBN Legal business name | GRAND VALLEY EQUINE ASSISTED LEARNING CENTER | ||||||||
| Authorized official | JAY D. MULLER - (CO-FOUINDER) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 05/19/2016 | ||||||||
| Last updated | 05/19/2016 - About 10 years ago | ||||||||
| Identifiers |
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