Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0331 | SD |
NPI | 1780971374 |
---|---|
Provider Name | Mrs. Sally Sisk |
First Address | Aberdeen, SD 57401-2159 |
Second Address | Aberdeen, SD 57401-2159 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 01/07/2011 |