Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT9075 | AL |
NPI | 1003146309 |
---|---|
Provider Name | Jill Jesse |
First Address | St. Augustine, FL 32086 |
Second Address | Pelham, AL 35124-2216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2010 |
Last Update Date | 08/01/2010 |