Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1333 | WY |
NPI | 1598325193 |
---|---|
Provider Name | Mrs. Katrina Rush |
First Address | Jackson, WY 83001-1287 |
Second Address | Jackson, WY 83001-8642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 17/06/2019 |