Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 2015025342 | MO |
NPI | 1023486321 |
---|---|
Provider Name | Kaitlin Nishida |
First Address | Arnold, MO 63010-6015 |
Second Address | Arnold, MO 63010-6015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2015 |
Last Update Date | 15/02/2017 |