Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT60067320 | WA |
NPI | 1245534080 |
---|---|
Provider Name | Johanna M Overhauser |
First Address | Nine Mile Falls, WA 99026 |
Second Address | Spokane, WA 99202-1201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 10/01/2011 |