Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | TA0114 | WI |
NPI | 1326496621 |
---|---|
Provider Name | Angela Estes |
First Address | Mooreville, MS 38857-0267 |
Second Address | Tupelo, MS 38804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 26/05/2016 |