Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00887700 | NJ |
N | 225X00000X | Occupational Therapist | OC016235 | PA |
N | 225XH1200X | Occupational Therapist - Hand | OC016235 | PA |
NPI | 1134773146 |
---|---|
Provider Name | Jessica Louise Carr |
First Address | Media, PA 19063-4708 |
Second Address | Voorhees, NJ 08043-4412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 07/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46TR00887700 | OT LICENSE (01) | NJ |
OC016235 | OT LICENSE (01) | PA |