Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT002961 | GA |
NPI | 1215132170 |
---|---|
Provider Name | Jennifer S Deyoung |
First Address | Ooltewah, TN 37363-6511 |
Second Address | Woodstock, GA 30189-5581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 30/04/2015 |