Individual
SANDRA K KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
223 ROOSEVELT AVE, MISHAWAKA, IN 46544-3349
(574) 340-8308
Mailing address
223 ROOSEVELT AVE, MISHAWAKA, IN 46544-3349
(574) 340-8308
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001215
IN
Other
Enumeration date
11/18/2019
Last updated
11/18/2019
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