Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 0112/00415TR/T | NJ |
NPI | 1114299807 |
---|---|
Provider Name | Mr. Jordan Kowalski |
First Address | Hackettstown, NJ 07840-1718 |
Second Address | Hackettstown, NJ 07840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2012 |
Last Update Date | 27/01/2012 |