Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | OT.0004147 | CO |
NPI | 1912385253 |
---|---|
Provider Name | Emma Linne |
First Address | Longmont, CO 80503-7938 |
Second Address | Fort Collins, CO 80525-7124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 06/05/2015 |