Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1114168135 |
---|---|
Provider Name | Kelly Wilkerson |
First Address | Kennewick, WA 99336-7171 |
Second Address | Kennewick, WA 99336-7171 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2009 |
Last Update Date | 20/03/2009 |