Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1043511983 |
---|---|
Provider Name | Mrs. Ruth Jewell |
First Address | San Antonio, TX 78260-4319 |
Second Address | San Antonio, TX 78229-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2010 |
Last Update Date | 09/11/2010 |