Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003451949 |
---|---|
Provider Name | Jessica Monarch |
First Address | Sierra Vista, AZ 85635-3949 |
Second Address | Sierra Vista, AZ 85635-4878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 14/11/2019 |