Individual
JESSICA UM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 MARTIN LUTHER KING JR DR, 432 FL ATKINS BUILDING, WINSTON-SALEM, NC 27110-0001
(336) 750-3174
Mailing address
601 MARTIN LUTHER KING JR DR, 432 FL ATKINS BLDG, WINSTON-SALEM, NC 27110-0001
(336) 750-3174
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
RBT-18-51065
NC
225X00000X
Occupational Therapist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2018
Last updated
09/08/2020
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