Individual
JAMIE LYNN TANTIWONGSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
168 QUARRY GLENN DR APT 705, WESTON, WV 26452-9690
(304) 838-0311
Mailing address
PO BOX 84, HORNER, WV 26372-0084
(304) 838-0311
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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