Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT0291 | MS |
NPI | 1477519635 |
---|---|
Provider Name | Kay Ann Host |
First Address | Biloxi, MS 39530-3656 |
Second Address | Sheppard Afb, TX 76311-3477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD 000 | (02) |