Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31004676A | IN |
NPI | 1205407533 |
---|---|
Provider Name | Krystal Walls |
First Address | Danville, IN 46122-8854 |
Second Address | Plainfield, IN 46168-8328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2021 |
Last Update Date | 07/07/2021 |