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Individual

JESSICA S FAIR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1000 CORPORATE DR, SUITE 280, FORT LAUDERDALE, FL 33334-3634
(954) 636-2525
Mailing address
648 CUMBERLAND DR, CELINA, OH 45822-1386

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
013100168
VA

Other

Enumeration date
11/02/2012
Last updated
03/25/2021
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