Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 17-02467 | KS |
NPI | 1235471152 |
---|---|
Provider Name | Mark Gitau |
First Address | Wichita, KS 67220-2218 |
Second Address | Wichita, KS 67208-1604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2013 |
Last Update Date | 18/03/2013 |