Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XF0002X | Feeding, Eating & Swallowing | ||
N | 2251H1300X | Human Factors | ||
N | 225XH1300X | Human Factors | ||
N | 225XL0004X | Low Vision | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1821465014 |
---|---|
Provider Name | Tonja Gilmore |
First Address | Yankton, SD 57078-6700 |
Second Address | Yankton, SD 57078-6700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2015 |
Last Update Date | 24/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029-9904-ET | CONTRACTOR'S EXCISE TAX LICENSE (01) | SD |