Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 057002938 | IL |
NPI | 1114395902 |
---|---|
Provider Name | Siena Gwandure |
First Address | Fishers, IN 46038-1942 |
Second Address | Fishers, IN 46038-1942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2015 |
Last Update Date | 10/09/2015 |