Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 31005171A | IN |
NPI | 1790450880 |
---|---|
Provider Name | Emily Smith |
First Address | Indianapolis, IN 46220-2208 |
Second Address | Indianapolis, IN 46202-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2021 |
Last Update Date | 11/08/2021 |