Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT466 | OK |
NPI | 1215156195 |
---|---|
Provider Name | Mrs. Kelly Shannon Brunsteter Misuraca |
First Address | Edmond, OK 73013-8378 |
Second Address | Oklahoma City, OK 73112-5550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |