Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056006591 | IL |
NPI | 1003222407 |
---|---|
Provider Name | Jennifer Marchbanks |
First Address | Saint Louis, MO 63150-4469 |
Second Address | Marseilles, IL 61341-1814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2014 |
Last Update Date | 07/07/2014 |