| NPI | 1164707840 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: PA OC007396L) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: PA OC007396L) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2016-12-04 |