Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023512043 |
---|---|
Provider Name | Nicole Pautz |
First Address | Boalsburg, PA 16827-1100 |
Second Address | Boalsburg, PA 16827-1100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2018 |
Last Update Date | 23/03/2018 |