Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 005230 | IA |
NPI | 1003254632 |
---|---|
Provider Name | Mrs. Kelsi Blair Lemon |
First Address | Omaha, NE 68144-2981 |
Second Address | Omaha, NE 68144-2981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2013 |
Last Update Date | 05/06/2013 |