Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0870 | SD |
NPI | 1003155987 |
---|---|
Provider Name | Kelly Peters |
First Address | Big Stone City, SD 57216-8237 |
Second Address | Watertown, SD 57201-3713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2013 |
Last Update Date | 28/08/2019 |