Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 5201009924 | |
Y | 225X00000X | Occupational Therapist | 60136462 | WA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 60136462 | WA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 60136462 | WA |
N | 225XR0403X | Driving and Community Mobility | 60136462 | WA |
NPI | 1962836536 |
---|---|
Provider Name | Jessica C Lewis |
First Address | Kentwood, MI 49508-6487 |
Second Address | Grand Rapids, MI 49503-5247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2013 |
Last Update Date | 17/03/2018 |