Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31004828A | IN |
NPI | 1174005748 |
---|---|
Provider Name | Joan Siders |
First Address | Greenfield, IN 46140-1014 |
Second Address | Greenfield, IN 46140-1014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |