Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 4765-026 | WI |
Y | 225XH1200X | Occupational Therapist - Hand | 31004979A | IN |
NPI | 1235462094 |
---|---|
Provider Name | Holly M Gutierrez |
First Address | Schererville, IN 46375-1562 |
Second Address | Schererville, IN 46375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2009 |
Last Update Date | 23/01/2019 |