Individual
OTAVIA JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
311 SALMON CT, KISSIMMEE, FL 34759-4724
(321) 614-7538
Mailing address
311 SALMON CT, KISSIMMEE, FL 34759-4724
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
04/11/2019
Last updated
04/11/2019
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