Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT007690 | OH |
NPI | 1003160656 |
---|---|
Provider Name | Jamie M Novak |
First Address | Beachwood, OH 44122-6054 |
Second Address | Beachwood, OH 44122-6054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2012 |
Last Update Date | 21/01/2013 |