Individual
JACQUELYN CAROL GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
17440 LA JUNTA ST, HESPERIA, CA 92345-7231
(760) 244-0425
Mailing address
PO BOX 400447, HESPERIA, CA 92340-0447
(760) 244-0425
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 7391
CA
Other
Enumeration date
06/13/2008
Last updated
06/13/2008
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