Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 31004430A | IN |
NPI | 1770800161 |
---|---|
Provider Name | Nichole Ann Oswald |
First Address | Beech Grove, IN 46107-1169 |
Second Address | Beech Grove, IN 46107-1169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 13/11/2012 |