Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 31000837A | IN |
NPI | 1023236817 |
---|---|
Provider Name | Ms. Elizabeth Ann Mora |
First Address | Whiting, IN 46394-1604 |
Second Address | Schererville, IN 46375-1277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |