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General NPI Number Information
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NPI Number | 1427467000
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Entity Type | Organization
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Legal Business Name | GOLD KEY OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 1405 ARCADIA DR
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City | FAIRMONT
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State | WV
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Zip | 26554-9164
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Country | US
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Telephone | 304-777-0517
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 ARCADIA DR
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City | FAIRMONT
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State | WV
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Zip | 26554-9164
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Country | US
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Telephone | 304-777-0517
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | MS. ASHLEY D ELZA
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Credential | O.T.R.
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Telephone | 304-777-0517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1565
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License Number State | WV
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