Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 1070098 | OR |
NPI | 1114349859 |
---|---|
Provider Name | Kimberly Birk-Fitzjarrald |
First Address | The Dalles, OR 97058-9403 |
Second Address | The Dalles, OR 97058-9403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2014 |
Last Update Date | 15/01/2014 |