Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner |
NPI | 1780185645 |
---|---|
Provider Name | Katherine Hanta Wallisch |
First Address | Las Vegas, NV 89135-5008 |
Second Address | Las Vegas, NV 89148-4903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 22/09/2020 |