Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 8137 | MA |
NPI | 1003011255 |
---|---|
Provider Name | Jennifer Jean Owen |
First Address | Hanover, MA 02339-2180 |
Second Address | Hanover, MA 02339-2180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 08/07/2007 |