Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 31003445A | IN |
NPI | 1164651576 |
---|---|
Provider Name | Mrs. Susan Marie Hanke |
First Address | Churubusco, IN 46723-9262 |
Second Address | Churubusco, IN 46723-9262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 07/07/2009 |