Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1704 | NH |
NPI | 1003030552 |
---|---|
Provider Name | Jessica Cunningham |
First Address | Concord, NH 03301-7911 |
Second Address | Gorham, NH 03581-1107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 13/01/2020 |