Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 31006619A | IN |
NPI | 1033696919 |
---|---|
Provider Name | Michaela Wadsworth |
First Address | Indianapolis, IN 46219-2406 |
Second Address | Indianapolis, IN 46219-2406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2018 |
Last Update Date | 24/07/2018 |