Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 001452 | OR |
NPI | 1053976647 |
---|---|
Provider Name | Laura Anne Jones |
First Address | Medford, OR 97504-4122 |
Second Address | Medford, OR 97504-4122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2019 |
Last Update Date | 08/05/2019 |