Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 17-02363 | KS |
N | 225XP0200X | Occupational Therapist - Pediatrics | 2007001568 | MO |
NPI | 1003947409 |
---|---|
Provider Name | J Gonterwitz |
First Address | Kansas City, MO 64108-2500 |
Second Address | Kansas City, MO 64108-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 07/12/2009 |