Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | KY |
NPI | 1003398306 |
---|---|
Provider Name | Emily Wilson |
First Address | Baxter, KY 40806-8418 |
Second Address | Cumberland, KY 40823-8107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |