Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C18354 | PA |
NPI | 1245268580 |
---|---|
Provider Name | Kathy J Adams |
First Address | Greenville, PA 16125-2106 |
Second Address | Greenville, PA 16125-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017959290005 | (05) | PA |
2208873 | (05) | OH |