Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0748 | NH |
NPI | 1023551231 |
---|---|
Provider Name | Miss Jennifer Gail Decatur |
First Address | Troy, NH 03465-2302 |
Second Address | Keene, NH 03431-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2016 |
Last Update Date | 21/11/2016 |