Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA002866 | OH |
NPI | 1023516861 |
---|---|
Provider Name | Jennifer Luyster |
First Address | North Canton, OH 44720-2593 |
Second Address | Adena, OH 43901-9607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2018 |
Last Update Date | 26/01/2018 |