Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31005931A | IN |
NPI | 1003278326 |
---|---|
Provider Name | Jordyn Hicks |
First Address | Haubstadt, IN 47639-8709 |
Second Address | New Harmony, IN 47631-9075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 25/03/2016 |