Individual
AMY M OLDERBAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
440 N HIAWATHA DR, CANTON, SD 57013
(605) 987-2621
Mailing address
440 N HIAWATHA DR, CANTON, SD 57013
(605) 987-2621
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0651
SD
Other
Enumeration date
07/24/2007
Last updated
07/24/2007
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