Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT002020 | GA |
NPI | 1013282326 |
---|---|
Provider Name | Paula Atrice Jones |
First Address | Eastman, GA 31023-3668 |
Second Address | Eastman, GA 31023-3668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 20/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT002020 | STATE LICENSE (01) | GA |