Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 1559 | ID |
NPI | 1003279357 |
---|---|
Provider Name | Kylee Michelle Permann |
First Address | Pocatello, ID 83201-4073 |
Second Address | Pocatello, ID 83201-4073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 04/04/2016 |