Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | BOTOCT00222178 | KY |
NPI | 1003284480 |
---|---|
Provider Name | Mara Childers |
First Address | Hippo, KY 41653-8331 |
Second Address | Hippo, KY 41653-8331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2015 |
Last Update Date | 02/09/2015 |