Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 3512 | CA |
NPI | 1154957280 |
---|---|
Provider Name | Jennifer Marie Macintire |
First Address | Livermore, CA 94550-9698 |
Second Address | Livermore, CA 94550-9698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2020 |
Last Update Date | 20/03/2020 |