Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 31002231A | IN |
NPI | 1073681011 |
---|---|
Provider Name | Kimberly Herring-Anthony |
First Address | Indianapolis, IN 46260-1873 |
Second Address | Indianapolis, IN 46260-1873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 06/03/2014 |