Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003304494 |
---|---|
Provider Name | Gabrielle Vincenza Jakub |
First Address | Westfield, NJ 07090-1109 |
Second Address | Maplewood, NJ 07040-2491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2018 |
Last Update Date | 01/05/2018 |