Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 327642 | KS |
NPI | 1013311430 |
---|---|
Provider Name | Adrian Matta |
First Address | Wichita, KS 67208 |
Second Address | Wichita, KS 67208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2014 |
Last Update Date | 14/10/2014 |