Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP008403 | PA |
NPI | 1023645033 |
---|---|
Provider Name | Jessica Anne Guldner |
First Address | Elysburg, PA 17824-7251 |
Second Address | Coal Township, PA 17866-9405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2020 |
Last Update Date | 27/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OP008403 | LICENSING BOARD (01) | PA |