Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OC010692 | PA |
NPI | 1497906002 |
---|---|
Provider Name | Jessica Martin |
First Address | Stevens, PA 17578-9582 |
Second Address | Lebanon, PA 17042-7446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 02/10/2008 |