Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2011014123 | MO |
NPI | 1013563428 |
---|---|
Provider Name | Kimberly R Harrold |
First Address | Cahokia, IL 62206-3113 |
Second Address | Cahokia, IL 62206-3113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |