Individual
JESSICA LYN BODARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPO, CPO
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CPO04202
CA
224P00000X
Prosthetist
CPO04202
CA
Other
Enumeration date
04/23/2019
Last updated
04/23/2019
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