Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC07230L | PA |
NPI | 1770803991 |
---|---|
Provider Name | Ms. Kay Marie Nichols-Wolfe |
First Address | Reading, PA 19603-1495 |
Second Address | Leesport, PA 19533-8705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 10/06/2010 |