Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | T-03815 | KS |
NPI | 1003226515 |
---|---|
Provider Name | Mrs. Juanita Rebecca Vollnogel |
First Address | Hutchinson, KS 67501-8683 |
Second Address | Inman, KS 67546-8016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 06/05/2014 |