Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 00755 | IA |
NPI | 1003084831 |
---|---|
Provider Name | Vicki Castle |
First Address | Ankeny, IA 50023-9798 |
Second Address | Ankeny, IA 50023-9798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 14/02/2008 |