Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023206497 |
---|---|
Provider Name | Miss Roman Haile |
First Address | Denver, CO 80231-5735 |
Second Address | Denver, CO 80231-5735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 10/10/2007 |