Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | TA2486 | MS |
NPI | 1023323995 |
---|---|
Provider Name | Latoya Jones |
First Address | Summit, MS 39666-9132 |
Second Address | Kosciusko, MS 39090-3242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2010 |
Last Update Date | 16/08/2010 |