Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC012317 | PA |
N | 225XG0600X | Occupational Therapist - Gerontology | OC012317 | PA |
NPI | 1871836288 |
---|---|
Provider Name | Mrs. Jenna E Alexander |
First Address | Fredonia, PA 16124-3029 |
Second Address | Warrenville, IL 60555-3938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2013 |
Last Update Date | 21/09/2016 |