Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4164 | AZ |
NPI | 1013172998 |
---|---|
Provider Name | Jamson Hendler |
First Address | Golden, CO 80403-2127 |
Second Address | Payson, AZ 85541-4263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2008 |
Last Update Date | 04/01/2018 |