Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 31000363A | IN |
NPI | 1700030897 |
---|---|
Provider Name | Mrs. Dianne Elaine King |
First Address | Plainfield, IN 46168-9604 |
Second Address | Plainfield, IN 46168-9604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2008 |
Last Update Date | 16/11/2008 |