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General NPI Number Information
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NPI Number | 1063957306
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Entity Type | Individual
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Provider Name | JENNIE PUGH
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Gender | Female
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 2300 CLAYTON RD SUITE 1170 THERAPISTS UNLIMITED GENESIS HEALTHCARE COMPANY
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City | CONCORD
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State | CA
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Zip | 94520
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Country | US
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Telephone | 925-726-0166
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Fax | 610-347-4838
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Provider Business Mailing Address
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Address Line | 2300 CLAYTON RD SUITE 1170 THERAPISTS UNLIMITED GENESIS HEALTHCARE COMPANY
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City | CONCORD
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State | CA
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Zip | 94520
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Country | US
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Telephone | 925-726-0166
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Fax | 610-347-4838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 958
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License Number State | CA
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