Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1164050456 |
---|---|
Provider Name | Jennifer Cook |
First Address | York, PA 17402-9001 |
Second Address | Gettysburg, PA 17325-6958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2020 |
Last Update Date | 31/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OC014560 | PA LICENSE (01) | PA |