Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003275173 |
---|---|
Provider Name | Kristin Hare |
First Address | Springfield, TN 37172-4801 |
Second Address | Springfield, TN 37172-4801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2016 |
Last Update Date | 18/02/2016 |