Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC014323 | PA |
NPI | 1942653761 |
---|---|
Provider Name | Miss Olumayowa Enoma |
First Address | Erie, PA 16504-1871 |
Second Address | Erie, PA 16504-1871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2016 |
Last Update Date | 16/07/2016 |