Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1932613650 |
---|---|
Provider Name | Jane Williams |
First Address | Steamboat Springs, CO 80487-9163 |
Second Address | Steamboat Springs, CO 80487-9163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2017 |
Last Update Date | 17/11/2017 |