Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 5905 | AZ |
NPI | 1013325232 |
---|---|
Provider Name | Jessica Ghetes |
First Address | Peoria, AZ 85383-3759 |
Second Address | Peoria, AZ 85383-3759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2014 |
Last Update Date | 31/07/2014 |