Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC014633 | PA |
NPI | 1003368812 |
---|---|
Provider Name | Kayla Corwin |
First Address | Erie, PA 16506-5802 |
Second Address | Erie, PA 16506-5802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2016 |
Last Update Date | 27/10/2016 |