Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1800783 | KS |
NPI | 1023421583 |
---|---|
Provider Name | Mr. Gerardo Ivan Espino SR. |
First Address | Wichita, KS 67205-1213 |
Second Address | Wichita, KS 67205-9402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 03/06/2014 |