Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | Z12442 | LA |
NPI | 1013217454 |
---|---|
Provider Name | Lynn Gibbs Jenkins |
First Address | Shreveport, LA 71103-4239 |
Second Address | Shreveport, LA 71103-4239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2010 |
Last Update Date | 02/11/2010 |