| NPI | 1972939965 |
|---|---|
| Former Name | JODI SUE FANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225XG0600X Occupational Therapist, Gerontology (Licence: NC 11215) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: FL 15330) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2021-11-24 |