Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 31002868A | IN |
NPI | 1952748055 |
---|---|
Provider Name | Cathy C Black |
First Address | Mount Vernon, IN 47620-8324 |
Second Address | Evansville, IN 47720-6142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2013 |
Last Update Date | 29/05/2013 |