Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 17-02491 | KS |
NPI | 1447648621 |
---|---|
Provider Name | Mrs. Bridget Ann Dinneen |
First Address | Saint Marys, KS 66536-1739 |
Second Address | Saint Marys, KS 66536-1739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2014 |
Last Update Date | 23/12/2014 |