Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | R4703 | KY |
NPI | 1679901748 |
---|---|
Provider Name | Mrs. Jill Suzanne Norris |
First Address | Louisville, KY 40214-4204 |
Second Address | Louisville, KY 40214-4204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2013 |
Last Update Date | 28/10/2013 |