Individual
MRS. JEANNIE L POOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
852 COMMERCE AVE, LONGVIEW, WA 98632-2406
(360) 501-3750
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 414-2048
(360) 575-6749
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0221530
LABOR & IND
WA
05
—
8483760
—
WA
01
—
8944617
CRIME VICTIMS
WA
Enumeration date
05/23/2007
Last updated
11/14/2007
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