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NPI 1891177523

NPI 1891177523 : MISS EMILY LEWIS : HURRICANE, WV

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General NPI Number Information
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    NPI Number           |    1891177523
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    Entity Type          |    Individual 
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    Provider Name        |    MISS EMILY LEWIS
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    06/18/2015
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    Last Update Date     |    06/24/2015
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Provider Practice Location Address
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    Address Line         |    300 SEVILLE RD 
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    City                 |    HURRICANE
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    State                |    WV
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    Zip                  |    25526
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    Country              |    US
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    Telephone            |    304-757-7805
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    PO BOX 428 
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    City                 |    ELEANOR
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    State                |    WV
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    Zip                  |    25070
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    Country              |    US
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    Telephone            |    304-545-4822
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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       |    1778
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    License Number State |    WV
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