| NPI | 1528314408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-07-30 |