Individual
JENNIFER KAYE WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1510 N GRAND AVE, TAHLEQUAH, OK 74464-6318
(918) 708-2119
Mailing address
PO BOX 573, FORT GIBSON, OK 74434-0573
(918) 681-0251
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1490
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100747120A
—
OK
Enumeration date
03/31/2021
Last updated
03/31/2021
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