Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00546500 | NJ |
N | 225XH1200X | Occupational Therapist - Hand | 46TR00546500 | NJ |
NPI | 1154610608 |
---|---|
Provider Name | Inessa Soden III |
First Address | Manahawkin, NJ 08050-2466 |
Second Address | Manahawkin, NJ 08050-2466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2011 |
Last Update Date | 20/01/2021 |