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General NPI Number Information
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NPI Number | 1700250248
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Entity Type | Organization
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Legal Business Name | WOMACK ARMY MEDICAL CENTER
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 215 ICE AVE 100
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City | DAYTON
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State | OH
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Zip | 45402
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Country | US
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Telephone | 937-554-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 215 ICE AVE UNIT 100
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City | DAYTON
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State | OH
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Zip | 45402-1762
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Country | US
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Telephone | 937-554-1900
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | ALLISON RACHELLE JORDAN
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Credential |
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Telephone | 937-554-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | OT007582
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License Number State | OH
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