Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2382 | NH |
NPI | 1518372143 |
---|---|
Provider Name | Melissa Peterson |
First Address | Laconia, NH 03246-2918 |
Second Address | Laconia, NH 03246-2918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 23/06/2014 |