Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 18-00806 | KS |
NPI | 1013399492 |
---|---|
Provider Name | Miss Amber Gasper |
First Address | Salina, KS 67401-7402 |
Second Address | Salina, KS 67401-7402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 23/06/2015 |