Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31007164A | IN |
NPI | 1154930014 |
---|---|
Provider Name | Elisabeth K. Taylor |
First Address | Fort Wayne, IN 46802-5962 |
Second Address | Fort Wayne, IN 46845-6002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2020 |
Last Update Date | 27/07/2020 |