Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | U1-0000977 | DE |
NPI | 1396255006 |
---|---|
Provider Name | Jeanne Marie Kanse |
First Address | Wilmington, DE 19808-2153 |
Second Address | Wilmington, DE 19808-1217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2017 |
Last Update Date | 08/10/2017 |