Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC008904 | PA |
NPI | 1255742086 |
---|---|
Provider Name | Kristina Bailey |
First Address | Lewisburg, PA 17837-1739 |
Second Address | Lewisburg, PA 17837-1739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 14/05/2014 |