Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 99047879A | IN |
NPI | 1003104332 |
---|---|
Provider Name | Katie Nordhoff |
First Address | Indianapolis, IN 46250-4736 |
Second Address | Indianapolis, IN 46250-4736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 20/07/2011 |