Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 31005397A |
NPI | 1033581822 |
---|---|
Provider Name | Kelly Garner |
First Address | Brownsburg, IN 46112-7207 |
Second Address | Indianapolis, IN 46234-2167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2015 |
Last Update Date | 20/10/2015 |