Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 06635 | MD |
N | 225X00000X | Occupational Therapist | 46TR00154000 | NJ |
N | 225XH1200X | Occupational Therapist - Hand | 46TR00154000 | NJ |
NPI | 1104034396 |
---|---|
Provider Name | Jyotsna R Supnekar |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Abingdon, MD 21009-1261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2007 |
Last Update Date | 18/07/2011 |