Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 426792 | OR |
NPI | 1003490012 |
---|---|
Provider Name | Kaylee Baze |
First Address | Salem, OR 97304-4263 |
Second Address | Salem, OR 97302-3954 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2021 |
Last Update Date | 06/05/2021 |