Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 46TR00568700 | NJ |
NPI | 1134683410 |
---|---|
Provider Name | Jeanna Spetgang |
First Address | Red Bank, NJ 07701-5723 |
Second Address | Cherry Hill, NJ 08034-3334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2019 |
Last Update Date | 23/04/2020 |