Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023586740 |
---|---|
Provider Name | Jenna Marie Stewart |
First Address | Bryan, TX 77802-5893 |
Second Address | College Station, TX 77845-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2018 |
Last Update Date | 12/11/2018 |