Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 00366 | IA |
NPI | 1922243898 |
---|---|
Provider Name | Elizabeth Marie Cole |
First Address | Fairfield, IA 52556-9090 |
Second Address | Omaha, NE 68144-2981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2008 |
Last Update Date | 08/12/2008 |