Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CX0006X | Orientation and Mobility Training Provider | 21664 | OH |
NPI | 1922669746 |
---|---|
Provider Name | Tommie Roesch |
First Address | Indianapolis, IN 46208-3300 |
Second Address | Indianapolis, IN 46208-3300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 24/06/2019 |