NPI | 1629645205 |
---|---|
Former Name | DESIRAE MARIE HYDE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: ID OT-2169) |
Additional Taxonomies | 225X00000X Occupational Therapist (Licence: ID OT-2169) |
Enumeration Date | 2021-06-10 |
Last Update Date | 2023-09-29 |