Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 244672 | KY |
NPI | 1013563386 |
---|---|
Provider Name | Emily Gaddie |
First Address | Bowling Green, KY 42101-4144 |
Second Address | Bowling Green, KY 42101-4144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2019 |
Last Update Date | 13/08/2019 |