Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 994 | WY |
N | 225XM0800X | Mental Health | OT-994 | WY |
NPI | 1992102552 |
---|---|
Provider Name | Jenny Lok |
First Address | Casper, WY 82609-4126 |
Second Address | Casper, WY 82609-4126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2014 |
Last Update Date | 02/06/2020 |