Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 006780 | OH |
N | 225X00000X | Occupational Therapist | 2467 | NM |
Y | 225XM0800X | Mental Health | 0003531 | CO |
NPI | 1699929372 |
---|---|
Provider Name | Mrs. Brooke Dana Wimer |
First Address | Pueblo, CO 81008-1900 |
Second Address | Pueblo, CO 81008-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2008 |
Last Update Date | 29/12/2017 |