Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1041714 | OR |
N | 225XM0800X | Mental Health |
NPI | 1063820520 |
---|---|
Provider Name | Heidi Romero |
First Address | Grants Pass, OR 97527-2544 |
Second Address | Grants Pass, OR 97527-2544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2014 |
Last Update Date | 29/07/2014 |