Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 001092 | MO |
NPI | 1003210147 |
---|---|
Provider Name | Mrs. Marcella Jane Hillman |
First Address | Overland Park, KS 66204-1497 |
Second Address | Overland Park, KS 66204-1497 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2014 |
Last Update Date | 17/10/2014 |