Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3752 | SC |
NPI | 1013531912 |
---|---|
Provider Name | Jacquelyn M Knox |
First Address | Charleston, SC 29492-8548 |
Second Address | Fountain Inn, SC 29644-9785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2020 |
Last Update Date | 05/06/2020 |