Individual
MR. JACK CONWAY GRIFFIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR'L CHT
Contact information
Practice address
125 BUENA VISTA CIR, SOUTH HILL, VA 23970-1431
(434) 447-3151
Mailing address
1200 ST TAMMANY DR, BRACEY, VA 23919-2006
(434) 636-4022
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119002487
VA
Other
Enumeration date
10/15/2012
Last updated
10/15/2012
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