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General NPI Number Information
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NPI Number | 1467889154
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Entity Type | Individual
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Provider Name | ELLEN JOST
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Gender | Female
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 308 JACKSON ST APT 113
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City | OAKLAND
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State | CA
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Zip | 94607-4354
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Country | US
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Telephone | 320-260-7872
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Fax |
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Provider Business Mailing Address
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Address Line | 45240 140TH ST
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City | DONNELLY
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State | MN
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Zip | 56235-1110
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Country | US
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Telephone |
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Fax |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 12746
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License Number State | CA
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