Individual
KIMI LAUREN VAN WIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CPO, LPO
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CPO-1994
TX
222Z00000X
Orthotist
LPO-362
TX
224P00000X
Prosthetist
CPO-1994
TX
224P00000X
Prosthetist
LPO-362
TX
Other
Enumeration date
08/17/2006
Last updated
10/07/2008
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