Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32002095A | IN |
NPI | 1003474313 |
---|---|
Provider Name | Amanda Teusch |
First Address | Huntington, IN 46750-1849 |
Second Address | Greentown, IN 46936-9163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2019 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32002095A | FIRST STEPS/EARLY INTERVENTION (01) | IN |