Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1093241192 |
---|---|
Provider Name | Mrs. Mary Petitt |
First Address | Owingsville, KY 40360-8906 |
Second Address | Owingsville, KY 40360-8906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2017 |
Last Update Date | 30/08/2017 |