Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | OF000220 | PA |
Y | 225200000X | Physical Therapy Assistant | TE009942 | PA |
NPI | 1639658370 |
---|---|
Provider Name | Kelsie Spaid |
First Address | Portage, PA 15946-6602 |
Second Address | Huntingdon, PA 16652-1518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |