Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 9310000148 | CA |
NPI | 1225047673 |
---|---|
Provider Name | Susan Diane Mitchell |
First Address | Baton Rouge, LA 70815-4442 |
Second Address | Baton Rouge, LA 70809-3478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 10/02/2009 |