| Name | Value |
|---|---|
| PROVIDER TYPE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| CLASSIFICATION | Specialist/Technologist |
| AREA OF SPECIALIZATION | Rehabilitation, Blind |
| STATUS | Inactive |
| DATE INACTIVATED | 2018-04-02 00:00:00 |
| VA CODE | V130404 |
| X12 CODE | 2255R0406X |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255162 |
| EFFECTIVE DATE/TIME |
|