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General NPI Number Information
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NPI Number | 1912228040
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Entity Type | Organization
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Legal Business Name | JOINT INTEGRITY HAND THERAPY, LLC
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 337 E MAIN ST
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City | CLARKSBURG
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State | WV
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Zip | 26301-2127
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Country | US
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Telephone | 304-366-4018
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Fax |
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Provider Business Mailing Address
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Address Line | 726 E PARK AVE PMB280
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City | FAIRMONT
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State | WV
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Zip | 26554-4115
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Country | US
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Telephone | 304-366-4018
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS WYCOFF
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Credential | OTR/L,CHT
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Telephone | 304-366-4018
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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 | 1073
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License Number State | WV
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