Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00003308 | WA |
NPI | 1003962945 |
---|---|
Provider Name | Kathryn M Heermann |
First Address | Puyallup, WA 98372-3709 |
Second Address | Puyallup, WA 98372-3709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |