Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 242685 | OR |
NPI | 1730303033 |
---|---|
Provider Name | Ms. Lynn M Jansky |
First Address | Big Stone Gap, VA 24219-2759 |
Second Address | Klamath Falls, OR 97601-7151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278773 | (05) | OR |