Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 99045604A | IN |
NPI | 1003112483 |
---|---|
Provider Name | Mrs. Ronda Carol Fox |
First Address | New Castle, IN 47362-4113 |
Second Address | New Castle, IN 47362-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2011 |
Last Update Date | 02/02/2011 |