Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H3431 | OR |
NPI | 1073959854 |
---|---|
Provider Name | Mrs. Katy Lee Sheeler |
First Address | Tigard, OR 97223-4192 |
Second Address | Tigard, OR 97223-4192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2013 |
Last Update Date | 20/05/2013 |