Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 5201005849 | MI |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201005849 | MI |
NPI | 1114579430 |
---|---|
Provider Name | Mrs. Jill Carpenter |
First Address | Kalamazoo, MI 49001-2860 |
Second Address | Kalamazoo, MI 49001-2860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2019 |
Last Update Date | 16/07/2019 |