Individual
JENNA DAULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1500 VILLA RD, SPRINGFIELD, OH 45503-1656
(937) 342-8424
Mailing address
333 S BIRD RD, SPRINGFIELD, OH 45505-1609
(614) 857-5602
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
05068
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05068
STATE LISCENSURE
OH
Enumeration date
07/30/2015
Last updated
07/30/2015
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