Individual
MRS. MARY JO FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTL
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
539460
OR
225X00000X
Occupational Therapist
Primary
OT-1786
ID
Other
Enumeration date
06/29/2017
Last updated
07/21/2022
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