Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT00000505 | WA |
NPI | 1053346965 |
---|---|
Provider Name | Lois E Kramer |
First Address | Gig Harbor, WA 98335-1722 |
Second Address | Gig Harbor, WA 98335-1722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7302584 | AETNA (01) | WA |
8384570 | (05) | WA |
KR5874 | REGENCE (01) | WA |