Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT19735 | CA |
NPI | 1821551722 |
---|---|
Provider Name | Jacqueline Wendy Monk |
First Address | Pacific Grove, CA 93950-5204 |
Second Address | Salinas, CA 93901-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2019 |
Last Update Date | 09/04/2019 |