Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 002022 | IA |
NPI | 1548561228 |
---|---|
Provider Name | Katie Lynn Douglas |
First Address | Ankeny, IA 50023-9798 |
Second Address | Ankeny, IA 50023-9798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2010 |
Last Update Date | 10/11/2010 |