Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2008001152 | MO |
NPI | 1568851806 |
---|---|
Provider Name | Elizabeth Wilmoth |
First Address | Raymore, MO 64083-9404 |
Second Address | Pheonix, AZ 85021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2015 |
Last Update Date | 09/01/2015 |