Individual
JAQUETTA GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1507 MAIN ST, CROSSETT, AR 71635-4125
(870) 364-5625
Mailing address
130 BLUEGRASS DR, MONTICELLO, AR 71655-9167
(870) 224-5800
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1162
AR
Other
Enumeration date
11/18/2024
Last updated
11/18/2024
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