Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 008431-1 | NY |
N | 224Z00000X | Occupational Therapy Assistant | 46TA09099800 | NJ |
NPI | 1003211376 |
---|---|
Provider Name | Mrs. Devora Jakob |
First Address | Lakewood, NJ 08701-3660 |
Second Address | Lakewood, NJ 08701-3660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2014 |
Last Update Date | 29/10/2014 |