Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP008398 | PA |
NPI | 1013410620 |
---|---|
Provider Name | Haylee Nicole Dietrich |
First Address | New Oxford, PA 17350-8903 |
Second Address | New Oxford, PA 17350-9582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2018 |
Last Update Date | 10/03/2018 |