Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 164592 | KY |
NPI | 1023627007 |
---|---|
Provider Name | Mrs. Brianna Keen Wood |
First Address | Woodburn, KY 42170-9745 |
Second Address | Bowling Green, KY 42104-5341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2020 |
Last Update Date | 27/07/2020 |