Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003236571 |
---|---|
Provider Name | Jenna Maki |
First Address | Duluth, MN 55805-1950 |
Second Address | Duluth, MN 55805-1950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2014 |
Last Update Date | 23/04/2014 |