Individual
JESSICA MARIE WILLETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2365 NASHVILLE RD, BOWLING GREEN, KY 42101-4144
(270) 782-9961
Mailing address
16868 GREENVILLE RD, LEWISBURG, KY 42256-8418
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A5178
KY
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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