Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 18-00941 | KS |
NPI | 1003210568 |
---|---|
Provider Name | Brandi Spiva |
First Address | Lawrence, KS 66046-5964 |
Second Address | Lawrence, KS 66049-3964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2014 |
Last Update Date | 13/10/2014 |