Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XH1200X | Occupational Therapist - Hand | 2415 | CA |
Y | 225XH1200X | Occupational Therapist - Hand | OT00004171 | WA |
NPI | 1184667149 |
---|---|
Provider Name | Julie Marie Gostin |
First Address | Port Orchard, WA 98367 |
Second Address | Port Orchard, WA 98367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |