Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 337371 | MO |
NPI | 1003209560 |
---|---|
Provider Name | Winter Witt |
First Address | Clinton, MO 64735-1543 |
Second Address | Warsaw, MO 65355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2015 |
Last Update Date | 09/03/2015 |