Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1110 | MA |
NPI | 1003091190 |
---|---|
Provider Name | Katherine Wyman |
First Address | West Boylston, MA 01583-1024 |
Second Address | Plymouth Meeting, PA 19462-1047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2008 |
Last Update Date | 08/01/2008 |