Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32000829A | IN |
NPI | 1013206879 |
---|---|
Provider Name | Kathy Diekhoff |
First Address | Evansville, IN 47712-6503 |
Second Address | Evansville, IN 47712-6503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 01/04/2011 |