Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023570173 |
---|---|
Provider Name | Nicole Gades |
First Address | Big Stone City, SD 57216-8237 |
Second Address | Big Stone City, SD 57216-8237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 05/04/2019 |