Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC016611 | PA |
NPI | 1417569799 |
---|---|
Provider Name | Courtney Lynn Schauer |
First Address | Wellsboro, PA 16901-6840 |
Second Address | Wellsboro, PA 16901-6840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2020 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OC016611 | COMMNWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUP (01) | PA |