Individual
JILL LACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1215 HOWARD LN, BELLAIRE, TX 77401-2705
(713) 213-9060
Mailing address
1215 HOWARD LN, BELLAIRE, TX 77401-2705
(713) 213-9060
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
108235
TX
Other
Enumeration date
06/09/2009
Last updated
06/09/2009
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