Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT0009 | MS |
NPI | 1255701561 |
---|---|
Provider Name | Mrs. Kay Aultman Eduardo |
First Address | Jackson, MS 39211-4618 |
Second Address | Flowood, MS 39232-9303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2015 |
Last Update Date | 29/09/2015 |