Individual
MRS. JACLYN MARIE UTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-7942
Mailing address
40 WOODSHIRE CV, JACKSON, TN 38305-1308
(812) 568-7417
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
3794
TN
Other
Enumeration date
08/01/2011
Last updated
08/01/2011
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