Individual
JACOB STEPHEN LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
3116 W. HARTFORD DR., PHOENIX, AZ 85053
(480) 544-8751
Mailing address
3116 W HARTFORD DR, PHOENIX, AZ 85053-1820
(480) 544-8751
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6921
AZ
Other
Enumeration date
06/08/2017
Last updated
07/21/2022
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