Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1073655106 |
---|---|
Provider Name | Mrs. Amy Mieger Journo |
First Address | Ellicott City, MD 21042-1435 |
Second Address | Ellicott City, MD 21042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 21/12/2018 |