Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1083 | NE |
NPI | 1578834073 |
---|---|
Provider Name | Mrs. Denise Carnahan |
First Address | Omaha, NE 68154-3733 |
Second Address | Fremont, NE 68025-2242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2012 |
Last Update Date | 16/01/2012 |