Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP005754 | PA |
NPI | 1013121300 |
---|---|
Provider Name | Jennifer Renee Heck |
First Address | Covington, PA 16917-9556 |
Second Address | Wellsboro, PA 16901-1829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |