| Name | Value |
|---|---|
| PROVIDER TYPE | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| CLASSIFICATION | Occupational Therapist |
| AREA OF SPECIALIZATION | Neurorehabilitation |
| STATUS | Active |
| VA CODE | V130107 |
| X12 CODE | 225XN1300X |
| SPECIALTY CODE | 67 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255219 |
| EFFECTIVE DATE/TIME |
|