Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1124547344 |
---|---|
Provider Name | Ms. Amanda Elnora Knight |
First Address | Bristol, VT 05443-5026 |
Second Address | Bristol, VT 05443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2017 |
Last Update Date | 19/09/2017 |