Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP006728 | PA |
NPI | 1013309699 |
---|---|
Provider Name | Anita Trask |
First Address | Kane, PA 16735-1519 |
Second Address | Kane, PA 16735-1519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2015 |
Last Update Date | 19/02/2015 |