Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT 1430 | CA |
NPI | 1265700702 |
---|---|
Provider Name | Ann Therese Jordan |
First Address | Encinitas, CA 92024-1905 |
Second Address | Encinitas, CA 92024-3558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2011 |
Last Update Date | 12/12/2011 |