Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 883 | NE |
NPI | 1013320852 |
---|---|
Provider Name | Winsome Backer |
First Address | Sutherland, NE 69165 |
Second Address | Sutherland, NE 69165-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 10/06/2014 |