Individual
CIERRA MICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1118 W CROSS ST, ANDERSON, IN 46011-9530
(765) 643-1504
Mailing address
1248 DORI LN, INDIANAPOLIS, IN 46260-1604
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003322A
IN
Other
Enumeration date
05/24/2018
Last updated
05/24/2018
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