Individual
MRS. JACLYN RENEE MASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
609 LAKE VISTA DR, JEFFERSON, GA 30549-4606
(540) 855-8525
Mailing address
609 LAKE VISTA DR, JEFFERSON, GA 30549-4606
(540) 855-8525
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
0131000570
VA
224Z00000X
Occupational Therapy Assistant
Primary
OTA002507
GA
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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