Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT1361 | MS |
NPI | 1003589896 |
---|---|
Provider Name | Jennifer Ros Craig |
First Address | Jackson, MS 39211-4515 |
Second Address | Madison, MS 39110-9299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2021 |
Last Update Date | 27/07/2021 |