Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31001067A | IN |
N | 225XH1200X | Occupational Therapist - Hand | 31001067A | IN |
NPI | 1174616791 |
---|---|
Provider Name | Anne L Mummert |
First Address | Lafayette, IN 47903-4699 |
Second Address | West Lafayette, IN 47906-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 07/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000758022 | ANTHEM PIN - IU HEALTH ARNETT (01) | IN |
200036740 | (05) | IN |