Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 255180 |
NPI | 1003173683 |
---|---|
Provider Name | Melissa Kay Kent |
First Address | Pueblo West, CO 81007-3513 |
Second Address | Pueblo West, CO 81007-3513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 19/04/2012 |