Individual
JACOB STEVEN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
9040A JACKSON AVE, JOINT BASE LEWIS MCCHORD, WA 98431-0001
(253) 968-1110
Mailing address
1635 SEQUALITCHEW DR # M-302, DUPONT, WA 98327-6847
(540) 246-2923
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT61507906
WA
Other
Enumeration date
01/17/2023
Last updated
06/03/2024
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