Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 31003446A | IN |
NPI | 1073664355 |
---|---|
Provider Name | Mrs. Holly E Rodgers |
First Address | Indianapolis, IN 46217-7014 |
Second Address | Indianapolis, IN 46217-7014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 08/07/2007 |