Individual
JESSICA LAZOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
215 DUNBAR CAVE RD STE A, CLARKSVILLE, TN 37043-8850
(931) 542-2739
Mailing address
3901 TYLER BROWN DR, CLARKSVILLE, TN 37040-2568
(931) 216-1817
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3054
TN
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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