Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 17-00791 | KS |
NPI | 1174117113 |
---|---|
Provider Name | Jandy Suzanne Wills |
First Address | Topeka, KS 66611-1701 |
Second Address | Topeka, KS 66611-1701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2021 |
Last Update Date | 20/02/2021 |