Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 990378 | OR |
NPI | 1932681533 |
---|---|
Provider Name | Jacqueline Lucas-Morris |
First Address | Medford, OR 97504-6241 |
Second Address | Medford, OR 97504-6241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |