Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 769 | NE |
NPI | 1003007436 |
---|---|
Provider Name | Mrs. Alisha Lee Ettleman |
First Address | Nebraska City, NE 68410-1930 |
Second Address | Nebraska City, NE 68410-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 09/08/2007 |