Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | OT009 | ID |
N | 225CA2400X | Assistive Technology Practitioner | OT009 | ID |
N | 225XH1200X | Occupational Therapist - Hand | OT009 | ID |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT009 | ID |
NPI | 1447343462 |
---|---|
Provider Name | Janice Kytle Seargent |
First Address | Idaho Falls, ID 83404-6472 |
Second Address | Idaho Falls, ID 83404-6472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 11/01/2012 |