Individual
JERUSHA OTIENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4600 HERITAGE TRACE PKWY, FORT WORTH, TX 76244-8900
(817) 741-9360
Mailing address
4600 HERITAGE TRACE PKWY, FORT WORTH, TX 76244-8900
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211239
TX
Other
Enumeration date
08/17/2018
Last updated
08/17/2018
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