Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1578826400 |
---|---|
Provider Name | Amber Pratt |
First Address | Santa Rosa, CA 95403-9067 |
Second Address | Santa Rosa, CA 95403-9067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 15/06/2012 |