| NPI | 1821514860 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 9750) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: FL 3689) |
| 225X00000X Occupational Therapist (Licence: FL 17596) | |
| 225X00000X Occupational Therapist (Licence: SC 5988) | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2020-11-09 |