Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 9683 | MA |
NPI | 1104300672 |
---|---|
Provider Name | Diane Louise Kraus |
First Address | Mashpee, MA 02649-2725 |
Second Address | Mashpee, MA 02649-2725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 20/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9683 | STATE OF MA OCCUPATIONAL THERAPY LICENSE (01) | MA |