Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 9525 | NC |
NPI | 1275922353 |
---|---|
Provider Name | Jessica Haney |
First Address | Camp Lejeune, NC 28547-2538 |
Second Address | Camp Lejeune, NC 28547-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2015 |
Last Update Date | 19/07/2021 |