Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | R3852 | KY |
NPI | 1700243839 |
---|---|
Provider Name | Amy Nelson |
First Address | Greenville, KY 42345-3279 |
Second Address | Greenville, KY 42345-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2016 |
Last Update Date | 20/01/2016 |