Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003467820 |
---|---|
Provider Name | Amy Stoddard |
First Address | Pueblo, CO 81007-7586 |
Second Address | Pueblo, CO 81004-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2019 |
Last Update Date | 23/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT.0006163 | COLORADO DORA (01) | CO |