Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | OC011606 | PA |
Y | 225X00000X | Occupational Therapist | OC011606 | PA |
NPI | 1003322629 |
---|---|
Provider Name | Carolyn Mills |
First Address | Lincoln University, PA 19352-8927 |
Second Address | West Grove, PA 19390-9485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/12/2017 |