Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.05815 | OH |
NPI | 1023417862 |
---|---|
Provider Name | Carlie Creque |
First Address | Jenera, OH 45841-8908 |
Second Address | Jenera, OH 45841-8908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 18/08/2014 |