Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 2210 | CO |
NPI | 1700124757 |
---|---|
Provider Name | Ms. Joan Marie Thyne |
First Address | Brush, CO 80723-2018 |
Second Address | Brush, CO 80723-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2013 |
Last Update Date | 25/01/2013 |