| NPI | 1902438856 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI LEDET Cota 260-243-1198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2020-02-09 |