Individual
JACQUELINE C HOSTETLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
30 NICKLAUS DR NW, ROME, GA 30165-9518
(706) 346-4666
(706) 232-9303
Mailing address
30 NICKLAUS DR NW, ROME, GA 30165-9518
(706) 346-4666
(706) 232-9303
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004490
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
777866008C
—
GA
Enumeration date
01/15/2007
Last updated
09/02/2016
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