Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA.4705 | OH |
NPI | 1003228370 |
---|---|
Provider Name | Jamie Gillette |
First Address | Toledo, OH 43606-1816 |
Second Address | Toledo, OH 43620-1430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2014 |
Last Update Date | 21/05/2014 |