Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 025055-01 | NY |
NPI | 1003414897 |
---|---|
Provider Name | Jenna Marie Wier |
First Address | West Seneca, NY 14224-3164 |
Second Address | Depew, NY 14043-1823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2020 |
Last Update Date | 08/11/2021 |