Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1829 | OK |
NPI | 1063912822 |
---|---|
Provider Name | Katrina Annette Gillham |
First Address | Newcastle, OK 73065-5988 |
Second Address | Thomas, OK 73668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2018 |
Last Update Date | 19/02/2018 |