Individual
MISS CHARYL LADONNE JADA JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1500 SHOREWOOD DR, BREMERTON, WA 98312-2323
(360) 670-9327
(360) 343-1902
Mailing address
1500 SHOREWOOD DR, BREMERTON, WA 98312-2323
(360) 670-9327
(360) 343-1902
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT60003424
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8957ST
REGENCE
—
Enumeration date
05/13/2008
Last updated
12/11/2020
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