Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 4651 | AZ |
NPI | 1003184896 |
---|---|
Provider Name | Ms. Jamie Lynn Anderson |
First Address | Sierra Vista, AZ 85635-3386 |
Second Address | Sierra Vista, AZ 85635-3386 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2011 |
Last Update Date | 07/12/2011 |