Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OC60402640 | WA |
NPI | 1023497252 |
---|---|
Provider Name | Jennie Coic |
First Address | Elma, WA 98541-9429 |
Second Address | Elma, WA 98541-9429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 20/05/2015 |