Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | A3104 | KY |
NPI | 1033315577 |
---|---|
Provider Name | Keisha Mayfield |
First Address | Owensboro, KY 42303-2769 |
Second Address | Denver, CO 80206-4084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |