Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 31003015A | IN |
NPI | 1326432493 |
---|---|
Provider Name | Mrs. Amy Marie Schortgen |
First Address | Fort Wayne, IN 46825-4155 |
Second Address | Fort Wayne, IN 46825-4155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 26/03/2015 |