Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | ||
N | 225X00000X | Occupational Therapist | 01130 | IA |
N | 225X00000X | Occupational Therapist | 056.004970 | IL |
NPI | 1972622140 |
---|---|
Provider Name | Mrs. Jenifer Lee Furness |
First Address | Davenport, IA 52804-2040 |
Second Address | Davenport, IA 52804-2040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 03/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
264560645 | (05) | IL |
3053065 | (05) | OH |
7100120570 | (05) | KY |