Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC012549 | PA |
Y | 225X00000X | Occupational Therapist | OT.008197 | OH |
NPI | 1003168881 |
---|---|
Provider Name | Callie Elizabeth Audet |
First Address | Canton, OH 44709-2312 |
Second Address | Canton, OH 44709-2312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2012 |
Last Update Date | 05/11/2014 |