Individual
JENNIFER COSTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3807, SOUTHAVEN, MS 38672
(714) 345-3268
Mailing address
3807 COBBLEWOOD DR, SOUTHAVEN, MS 38672-6557
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
12/29/2021
Last updated
12/29/2021
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