Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053438531 |
---|---|
Provider Name | Jolene Kelly Eccles |
First Address | Lancaster, CA 93534-2531 |
Second Address | Huntington Park, CA 90255-3699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 07/12/2021 |