Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 6142 | AZ |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1412 | ND |
NPI | 1043604218 |
---|---|
Provider Name | Brittany Jean Schock |
First Address | Mandan, ND 58554-4813 |
Second Address | Mandan, ND 58554-3144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2015 |
Last Update Date | 30/09/2019 |