Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | Z10398 | LA |
NPI | 1053517441 |
---|---|
Provider Name | Vicki Ross Jensen |
First Address | Kenner, LA 70065-1004 |
Second Address | Kenner, LA 70065-1004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |