Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 31001354A | IN |
NPI | 1770805152 |
---|---|
Provider Name | Mr. Daren Scott Bootcheck |
First Address | Marion, IN 46952 |
Second Address | Marion, IN 46952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2010 |
Last Update Date | 25/02/2010 |