Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | ||
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1902009871 |
---|---|
Provider Name | Mrs. Kathy P. Griepenstroh |
First Address | Lamar, IN 47550-7267 |
Second Address | Lamar, IN 47550-7267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 30/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
IN000034153 | LICENSE # IN000034153 (01) | IN |