Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 17-00420 | KS |
NPI | 1003037078 |
---|---|
Provider Name | Mrs. Emily Ellen Borovetz |
First Address | Shawnee, KS 66226 |
Second Address | Olathe, KS 66061 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |