Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023682184 |
---|---|
Provider Name | Elizabeth A Proctor |
First Address | Ottumwa, IA 52501-8874 |
Second Address | Ottumwa, IA 52501-2165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2021 |
Last Update Date | 13/05/2021 |