Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1800701 | KS |
NPI | 1013224666 |
---|---|
Provider Name | Mrs. Kimberly Renee Breitenbach |
First Address | Osawatomie, KS 66064-1703 |
Second Address | Osawatomie, KS 66064-1703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2010 |
Last Update Date | 02/09/2010 |