Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT 00003983 | WA |
NPI | 1215307251 |
---|---|
Provider Name | Ms. Roberta H Caseldine |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Tumwater, WA 98501-6523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2015 |
Last Update Date | 16/08/2016 |