Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 133572 | KY |
NPI | 1003931809 |
---|---|
Provider Name | Alisia Dawn Stevens |
First Address | Bandana, KY 42022-0033 |
Second Address | Bandana, KY 42022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 26/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133572 | KENTUCKY STATE LICENSE (01) | KY |