Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT-597 | GA |
NPI | 1518277359 |
---|---|
Provider Name | Jacqueline Jones |
First Address | Newnan, GA 30263-5672 |
Second Address | Newnan, GA 30263-5672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2010 |
Last Update Date | 14/10/2010 |