Individual
JORGE RAMOS MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
2320 BORST AVE, CENTRALIA, WA 98531-1410
(360) 827-6383
Mailing address
4749 WAXWING CT NE, LACEY, WA 98516-4534
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC60786993
WA
Other
Enumeration date
09/07/2017
Last updated
09/07/2017
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