Individual
JENNA POTZ-NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
122 KIOWA DR N, LAKE KIOWA, TX 76240-9534
(940) 634-2734
Mailing address
122 KIOWA DR N, LAKE KIOWA, TX 76240-9534
(940) 634-2734
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3464
NM
Other
Enumeration date
01/12/2016
Last updated
01/12/2016
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