Individual
JESSICA PROVANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
75 HICKLE ST, UNIONTOWN, PA 15401-4350
(724) 437-9871
Mailing address
75 HICKLE ST, UNIONTOWN, PA 15401-4350
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC013543
PA
Other
Enumeration date
01/30/2019
Last updated
01/30/2019
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