Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023530318 |
---|---|
Provider Name | Miss Hannah Joy Bollman |
First Address | Keizer, OR 97303-6399 |
Second Address | Sublimity, OR 97385-9714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2017 |
Last Update Date | 09/07/2017 |