Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 056.009706 | IL |
Y | 225XG0600X | Occupational Therapist - Gerontology | 133707 | KY |
NPI | 1790035624 |
---|---|
Provider Name | Mary Elizabeth Collier |
First Address | Eddyville, KY 42038-7516 |
Second Address | Cadiz, KY 42211-6520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2012 |
Last Update Date | 04/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1790035624 | (05) | KY |