Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 097192 | IA |
N | 225XF0002X | Feeding, Eating & Swallowing | 097192 | IA |
NPI | 1346892395 |
---|---|
Provider Name | Taylor Rae Crane |
First Address | Clive, IA 50325-8616 |
Second Address | Clive, IA 50325-8616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2019 |
Last Update Date | 10/07/2019 |