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General NPI Number Information
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NPI Number | 1821551722
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Entity Type | Individual
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Provider Name | JACQUELINE WENDY MONK
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Gender | Female
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 637 E ROMIE LN
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City | SALINAS
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State | CA
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Zip | 93901-4205
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Country | US
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Telephone | 831-424-0687
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Fax |
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Provider Business Mailing Address
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Address Line | 340 BISHOP AVE
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City | PACIFIC GROVE
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State | CA
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Zip | 93950-5204
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Country | US
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Telephone | 772-631-1821
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | OT19735
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License Number State | CA
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