Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2016031420 | MO |
NPI | 1366985202 |
---|---|
Provider Name | Courtney Noel Hogan |
First Address | Winfield, MO 63389-2508 |
Second Address | Chesterfield, MO 63017-5812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2016 |
Last Update Date | 27/11/2016 |