Individual
JERRY FOMBAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7803 BARN SWALLOW DR, FRISCO, TX 75036-5259
(678) 464-5790
Mailing address
7803 BARN SWALLOW DR, FRISCO, TX 75036-5259
(678) 464-5790
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213095
TX
Other
Enumeration date
09/05/2025
Last updated
09/05/2025
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