Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 01468 | IA |
N | 225XE0001X | Environmental Modification | 01468 | IA |
N | 2251E1200X | Ergonomics | 01468 | IA |
N | 225XE1200X | Ergonomics | 01468 | IA |
N | 225XG0600X | Occupational Therapist - Gerontology | 01468 | IA |
NPI | 1316187248 |
---|---|
Provider Name | Mrs. Nicole Marie O'gara |
First Address | Waverly, IA 50677-4389 |
Second Address | Waverly, IA 50677-4389 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2009 |
Last Update Date | 05/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0665802 | (05) | IA |
0665992 | (05) | IA |