Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 31001961A | IN |
NPI | 1013136365 |
---|---|
Provider Name | Mrs. Jennifer G. Stephenson |
First Address | Indianapolis, IN 46256-3494 |
Second Address | Indianapolis, IN 46256-3494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 09/07/2007 |