| NPI | 1285076992 |
|---|---|
| Former Name | JENNIFER LAUREN FARGO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: FL OT18691) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA oc012829) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2021-09-20 |