Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1023558632 |
---|---|
Provider Name | Katie Ostrom |
First Address | Traverse City, MICHIGAN 49696 |
Second Address | Traverse City, MI 49696-8980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2017 |
Last Update Date | 01/03/2017 |