Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5054 | SC |
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1730602715 |
---|---|
Provider Name | Katherine Jones |
First Address | Summerville, SC 29483-6032 |
Second Address | Summerville, SC 29483-3752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2017 |
Last Update Date | 14/10/2020 |