Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 163168 | KY |
NPI | 1578226973 |
---|---|
Provider Name | Jo Anna Sharp |
First Address | Glendale, KY 42740-8320 |
Second Address | Glendale, KY 42740-8320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2021 |
Last Update Date | 21/10/2021 |