Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 3156 | SC |
NPI | 1871936526 |
---|---|
Provider Name | Kayla Ann Banks |
First Address | Simpsonville, SC 29680-7659 |
Second Address | Anderson, SC 29621-2004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 12/04/2013 |