Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003066622 |
---|---|
Provider Name | Jeanette Jay Petro |
First Address | Painesville, OH 44077-1616 |
Second Address | Painesville, OH 44077-1616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2008 |
Last Update Date | 17/07/2015 |