Individual
VIRENDER K GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
15 EVONVALE COURT, GREENVILLE, SC 29605
(509) 431-2795
Mailing address
15 EVONVALE CT, GREENVILLE, SC 29605-5978
(509) 431-2795
Taxonomy
Speciality
Code
Description
License number
State
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
3389
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0192967
L&I
WA
05
—
8414856
—
WA
Enumeration date
07/06/2006
Last updated
07/30/2012
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