Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 368782 | CO |
NPI | 1003348533 |
---|---|
Provider Name | Michelle Hendershot |
First Address | Denver, CO 80209-2056 |
Second Address | Denver, CO 80209-2056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 03/04/2017 |