Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003278839 |
---|---|
Provider Name | Jenna Braswell |
First Address | Stokesdale, NC 27357-9346 |
Second Address | Stokesdale, NC 27357-9346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 22/03/2016 |