Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 3117 | NC |
NPI | 1003013855 |
---|---|
Provider Name | Misty Amber Oakes |
First Address | Bremerton, WA 98310-4306 |
Second Address | Bremerton, WA 98310-3313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 08/07/2007 |