Individual
MS. GWEN ELLEN NIEDERMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
215 DAVIS RD, OSSIAN, IN 46777
(260) 622-7821
(260) 622-4370
Mailing address
2625 GLENWOOD AVE, FORT WAYNE, IN 46805
(260) 482-2279
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000976A
IN
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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