Individual
MRS. JESSICA ROSE LOOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTRL
Contact information
Practice address
3205 SUPPLY RD, TRAVERSE CITY, MI 49696-9486
(231) 935-1070
Mailing address
7847 LARSON RD SW, SOUTH BOARDMAN, MI 49680-8602
(810) 429-3773
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201008393
MI
Other
Enumeration date
10/29/2015
Last updated
02/16/2018
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