Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OC018225 | PA |
NPI | 1063172997 |
---|---|
Provider Name | Kristina Lorraine Fenske-Vincent |
First Address | South Pasadena, CA 91030-4032 |
Second Address | Danville, PA 17821-1547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2021 |
Last Update Date | 20/12/2021 |