Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 12947 | MA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 06596 | MD |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTR2857 | AR |
NPI | 1255798989 |
---|---|
Provider Name | Jennifer Wade |
First Address | Fayetteville, AR 72703-4005 |
Second Address | Rogers, AR 72758-8602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2016 |
Last Update Date | 03/06/2021 |