Individual
JACQUELINE MARIE ROUTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2770 S ADAMS ST, BLOOMINGTON, IN 47403-3242
(727) 612-9096
Mailing address
3147 E MATTATHA DR, BLOOMINGTON, IN 47401-9415
(727) 612-9096
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003249A
IN
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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