Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1609426519 |
---|---|
Provider Name | Caroline Silva Pereira Lara Ribeiro |
First Address | Clive, IA 50325 |
Second Address | Clive, IA 50325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2019 |
Last Update Date | 13/09/2019 |