Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 2019006741 | MO |
Y | 225X00000X | Occupational Therapist | 264203 | KY |
NPI | 1003374463 |
---|---|
Provider Name | Mrs. Jennifer G Swann |
First Address | Louisville, KY 40241-2851 |
Second Address | Louisville, KY 40241-2851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2019 |
Last Update Date | 21/10/2020 |