Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 11359 | FL |
Y | 224Z00000X | Occupational Therapy Assistant | 3219 | SC |
NPI | 1003244633 |
---|---|
Provider Name | Jill Desmond |
First Address | Pomaria, SC 29126-8663 |
Second Address | Pomaria, SC 29126-8663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2013 |
Last Update Date | 16/10/2013 |