Individual
JESSICA PAULINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1000 LINCOLN DR, SOUTH CHARLESTON, WV 25309-2304
(304) 768-4400
Mailing address
113 GLOVER ST, PORTSMOUTH, OH 45662-4627
(304) 444-8573
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C2392
WV
Other
Enumeration date
10/12/2021
Last updated
10/12/2021
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