Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1609337195 |
---|---|
Provider Name | Kristen Alexis Yamnitz |
First Address | Perryville, MO 63775-1673 |
Second Address | Perryville, MO 63775-1673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |