Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 000814 | IA |
NPI | 1003272758 |
---|---|
Provider Name | Wendy Tireman |
First Address | Story City, IA 50248-1454 |
Second Address | Story City, IA 50248-1454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2016 |
Last Update Date | 11/01/2016 |