Individual
JACOB MILES WARDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
308 CYPRESS SPRINGS DR, BELTON, TX 76513-5316
(254) 718-4398
Mailing address
308 CYPRESS SPRINGS DR, BELTON, TX 76513-5316
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
116420
TX
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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