Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 00559 | OH |
NPI | 1013336528 |
---|---|
Provider Name | Theresa Kinkead |
First Address | Wooster, OH 44691-1246 |
Second Address | Wooster, OH 44691-1246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2014 |
Last Update Date | 11/04/2014 |