Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA046917 | AZ |
NPI | 1023787793 |
---|---|
Provider Name | Jessica Hope Quell |
First Address | Phoenix, AZ 85044-1778 |
Second Address | Phoenix, AZ 85021-8585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2021 |
Last Update Date | 07/09/2021 |