Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 31003657A | IN |
NPI | 1336512656 |
---|---|
Provider Name | Jennifer Bartek |
First Address | Evansville, IN 47720-1335 |
Second Address | Evansville, IN 47720-1335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2015 |
Last Update Date | 09/11/2015 |