| Name | Value |
|---|---|
| PROVIDER TYPE | Respiratory, Rehabilitative and Restorative Service |
| CLASSIFICATION | Other |
| AREA OF SPECIALIZATION | Rehabilitation Counselor |
| STATUS | Inactive |
| DATE INACTIVATED | 1998-10-20 00:00:00 |
| VA CODE | V130211 |
| reserved | P398 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255348 |
| EFFECTIVE DATE/TIME |
|