Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31004440A | IN |
NPI | 1003072083 |
---|---|
Provider Name | Mrs. Keisha N Creager |
First Address | Greenwood, IN 46142-2137 |
Second Address | Greenwood, IN 46142-2137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2008 |
Last Update Date | 30/07/2008 |