Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 08307 | MD |
NPI | 1003369984 |
---|---|
Provider Name | Miss Tierra Nicole Jones |
First Address | Randallstown, MD 21133-4349 |
Second Address | Baltimore, MD 21201-1590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2016 |
Last Update Date | 03/05/2021 |