Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0805 | SD |
NPI | 1104165950 |
---|---|
Provider Name | Seth Luoma |
First Address | Watertown, SD 57201-1537 |
Second Address | Watertown, SD 57201-1537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2013 |
Last Update Date | 13/02/2013 |