Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31005110A | IN |
N | 225XM0800X | Mental Health | 31005110A | IN |
N | 225XP0200X | Occupational Therapist - Pediatrics | 31005110A | IN |
NPI | 1639478787 |
---|---|
Provider Name | Mrs. Bobbie Jo Vergo |
First Address | Indianapolis, IN 46220-6707 |
Second Address | Indianapolis, IN 46220-6707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2011 |
Last Update Date | 15/03/2011 |