Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003254129 |
---|---|
Provider Name | Amanda H Jennings |
First Address | Dalton Gardens, ID 83815-9245 |
Second Address | Sandpoint, ID 83864-5054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 11/06/2013 |