| NPI | 1477000958 |
|---|---|
| Other Name | MICKIE PHONHNABOTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224Z00000X Occupational Therapy Assistant (Licence: NV ota-2887) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: TX 213493) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2022-01-07 |