Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31007039A | IN |
NPI | 1003433632 |
---|---|
Provider Name | Marisa Kitt |
First Address | Indianapolis, IN 46227-5093 |
Second Address | Indianapolis, IN 46227-5093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 30/06/2020 |