Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT-878 | ID |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT-878 | ID |
NPI | 1497903934 |
---|---|
Provider Name | Kc Austin |
First Address | Pocatello, ID 83201-4063 |
Second Address | Pocatello, ID 83201-4063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 08/09/2008 |