Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 201562 | MN |
Y | 224Z00000X | Occupational Therapy Assistant | 4524 | AZ |
NPI | 1013222595 |
---|---|
Provider Name | Mona Wolf |
First Address | Show Low, AZ 85901-7309 |
Second Address | Show Low, AZ 85901-7920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2010 |
Last Update Date | 09/08/2010 |