Individual
JESSICA ELAINE UMHOLTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
307 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1500
(765) 463-2200
(765) 463-3625
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003104A
IN
Other
Enumeration date
08/30/2019
Last updated
09/13/2021
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