Individual
JENNY GANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
918 S MOUNT OLIVE ST, SILOAM SPRINGS, AR 72761-4220
(479) 967-2322
Mailing address
PO DRAWER 2109, RUSSELLVILLE, AR 72811
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR2457
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AR
Enumeration date
02/26/2016
Last updated
02/26/2016
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