Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XH1200X | Occupational Therapist - Hand | 103345 | MN |
Y | 225XH1200X | Occupational Therapist - Hand | 3962 | TN |
NPI | 1083719777 |
---|---|
Provider Name | Jessica Sue Trautschold |
First Address | Nashville, TN 37204-3708 |
Second Address | Murfreesboro, TN 37129-2567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 23/11/2016 |