Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT00001747 | WA |
NPI | 1003832213 |
---|---|
Provider Name | Ms. Connie Crum |
First Address | Sumner, WA 98390-0480 |
Second Address | Puyallup, WA 98372 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 16/02/2011 |