Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 31004771A | IN |
Y | 225XH1200X | Occupational Therapist - Hand | 31004771A | IN |
NPI | 1174721039 |
---|---|
Provider Name | Mrs. Kathilyn N Teague |
First Address | Indianapolis, IN 46280-1393 |
Second Address | Bloomington, IN 47403-2124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 10/09/2018 |