Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 31006364A | IN |
NPI | 1003432915 |
---|---|
Provider Name | Holly Guenther |
First Address | New Haven, IN 46774-9571 |
Second Address | Fort Wayne, IN 46805-1617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2020 |
Last Update Date | 17/06/2020 |