Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CO |
NPI | 1538257027 |
---|---|
Provider Name | Paulett R Wentworth |
First Address | Colorado Springs, CO 80907 |
Second Address | Colorado Springs, CO 80907-3739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |