Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | BOTOCT00217413 | KY |
NPI | 1104287192 |
---|---|
Provider Name | Jasmine Thomas |
First Address | Easton, PA 18040-7958 |
Second Address | Louisville, KY 40222-9050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2016 |
Last Update Date | 17/03/2016 |