Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00815100 | NJ |
NPI | 1003303686 |
---|---|
Provider Name | Alexis Kristen |
First Address | Cherry Hill, NJ 08003-1000 |
Second Address | Cherry Hill, NJ 08003-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 18/04/2018 |