Individual
WINSOME BACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTAQ
Contact information
Practice address
333 MAPLE ST, SUTHERLAND, NE 69165-3000
(908) 386-4393
Mailing address
PO BOX 307, SUTHERLAND, NE 69165
(908) 386-4393
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
883
NE
Other
Enumeration date
06/10/2014
Last updated
06/10/2014
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