Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023277159 |
---|---|
Provider Name | Jennifer Edmondson |
First Address | Williamston, NC 27892-9708 |
Second Address | Edenton, NC 27932-8503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 04/06/2008 |