Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32001786A | IN |
NPI | 1013231141 |
---|---|
Provider Name | Janet L Prater |
First Address | Fort Wayne, IN 46805-4411 |
Second Address | Fort Wayne, IN 46805-4411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 18/03/2010 |