Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 03624 | OH |
NPI | 1003151911 |
---|---|
Provider Name | Mrs. Nancy Sue Anders |
First Address | Roseville, OH 43777-9796 |
Second Address | New Lexington, OH 43764-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2012 |
Last Update Date | 04/12/2012 |