Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 00713 | IA |
NPI | 1013174713 |
---|---|
Provider Name | Mary Renae Huff |
First Address | West Des Moines, IA 50266-1305 |
Second Address | West Des Moines, IA 50266-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0665190 | (05) | IA |