Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2048 | NE |
NPI | 1154873115 |
---|---|
Provider Name | Brittney Woodward |
First Address | North Platte, NE 69101-7641 |
Second Address | North Platte, NE 69101-7641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 25/10/2016 |