Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 173627 | KY |
NPI | 1003496456 |
---|---|
Provider Name | Matthew T Jones |
First Address | Shepherdsville, KY 40165-5693 |
Second Address | Louisville, KY 40272-2505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2021 |
Last Update Date | 10/04/2021 |