Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 13845 | MA |
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1750971388 |
---|---|
Provider Name | Jenna Wozniak |
First Address | Glenview, IL 60026-8001 |
Second Address | Springfield, MA 01109-2067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2021 |
Last Update Date | 19/01/2021 |