Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1773 | NE |
N | 225XG0600X | Occupational Therapist - Gerontology | 1773 | NE |
NPI | 1346751476 |
---|---|
Provider Name | Mrs. Maddie Mae Piittmann |
First Address | Council Bluffs, IA 51503-6616 |
Second Address | Omaha, NE 68104-1137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2017 |
Last Update Date | 16/10/2017 |