Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 0119000928 | VA |
NPI | 1720409105 |
---|---|
Provider Name | Ms. Jane Patricia Stockdale |
First Address | Yorktown, VA 23693-3529 |
Second Address | Yorktown, VA 23693-3529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2014 |
Last Update Date | 02/01/2014 |