Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 31002172A | IN |
Y | 225XH1200X | Occupational Therapist - Hand | 31002172A | IN |
NPI | 1285669887 |
---|---|
Provider Name | Amy Bosela |
First Address | Elkhart, IN 46514-1228 |
Second Address | Elkhart, IN 46514-1228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 22/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200532580 | (05) | IN |