| NPI | 1326246125 |
|---|---|
| Former Name | JENNIFER LYNN MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: ND 615) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 120605) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2007-07-08 |