Individual
EMILY WAKE
Active
Individual
EMILY WAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
31006339A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CEP843288322
BLUECROSS BLUESHIELD
—
Enumeration date
04/19/2017
Last updated
04/19/2017
Update your record
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