Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1326A | SC |
NPI | 1912299538 |
---|---|
Provider Name | Kimberly Miro |
First Address | Simpsonville, SC 29680-7063 |
Second Address | Greenville, SC 29607-5842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2011 |
Last Update Date | 15/05/2011 |