Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0590 | SD |
NPI | 1083867907 |
---|---|
Provider Name | Jill Doyle |
First Address | Pierre, SD 57501-4154 |
Second Address | Pierre, SD 57501-4154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 23/10/2008 |