Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1717-02990 | KS |
NPI | 1205239092 |
---|---|
Provider Name | Kelsey Lueger |
First Address | Topeka, KS 66604-1851 |
Second Address | Topeka, KS 66604-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2014 |
Last Update Date | 07/10/2014 |