Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 046947 | AZ |
NPI | 1023781796 |
---|---|
Provider Name | Kristina Laugen |
First Address | Gilbert, AZ 85298-4148 |
Second Address | Gilbert, AZ 85234-2750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2021 |
Last Update Date | 29/07/2021 |