Individual
JENNA PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(605) 347-2511
Mailing address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTP-OT-LIC-5358
MT
Other
Enumeration date
09/30/2019
Last updated
09/30/2019
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