Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003364324 |
---|---|
Provider Name | Mrs. Jessica Eno |
First Address | Marlton, NJ 08053-3742 |
Second Address | Marlton, NJ 08053-3742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2016 |
Last Update Date | 15/09/2016 |