Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1764 | NE |
NPI | 1336691351 |
---|---|
Provider Name | Mary Jane Holmes |
First Address | Papillion, NE 68046-2548 |
Second Address | Papillion, NE 68046-2548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 25/10/2016 |