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General NPI Number Information
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NPI Number | 1518590983
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Entity Type | Individual
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Provider Name | JAMES MA OTR/L
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Gender | Male
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 4500 8TH DIVISION RD
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City | COLUMBIA
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State | SC
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Zip | 29207-5700
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Country | US
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Telephone | 37-510-4868
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Fax |
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Provider Business Mailing Address
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Address Line | 2817 REILLY ROAD WOMACK ARMY MEDICAL CENTER
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City | FORT BRAGG
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State | NC
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Zip | 28310
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Country | US
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Telephone | 910-907-8922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 056.012809
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License Number State | IL
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