NPI | 1720223282 |
---|---|
Former Name | KRISTY ELLEN WIENECKE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: NY 015492-1) |
Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 015492-1) |
Enumeration Date | 2008-12-11 |
Last Update Date | 2014-12-23 |