Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner | ||
N | 225XE0001X | Environmental Modification |
NPI | 1003279225 |
---|---|
Provider Name | Kimberly Pace |
First Address | Harvey, LA 70058-7300 |
Second Address | Harvey, LA 70058-7300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 21/10/2021 |