Individual
LATRONDA JAQUETTE LORNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12388 SHADY DALE RD, MARIETTA, OK 73448-7327
(580) 504-4512
Mailing address
12388 SHADY DALE RD, MARIETTA, OK 73448-7327
(580) 504-4512
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
212021
TX
224Z00000X
Occupational Therapy Assistant
Primary
814
OK
Other
Enumeration date
01/24/2019
Last updated
01/24/2019
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