Individual
JENNIFER ANNE GENTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1315 WALNUT ST, TEXARKANA, TX 75501-4446
(903) 794-2705
(903) 793-1203
Mailing address
1315 WALNUT ST, TEXARKANA, TX 75501-4446
(903) 794-2705
(903) 793-1203
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213068
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021289601
—
TX
Enumeration date
01/19/2015
Last updated
01/19/2015
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