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Individual
TAM LE
Active
Individual
TAM LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
359551
OR
283X00000X
Rehabilitation Hospital
—
NULL
Other
Enumeration date
01/04/2017
Last updated
09/17/2019
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