Individual
JACQUELYN COMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2120 MARSHALL EDWARDS DR, BARTOW, FL 33830-6731
(863) 534-1862
(863) 533-5458
Mailing address
3210 BIG VALLEY DR, LAKELAND, FL 33813-4397
(863) 648-9781
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
COTA9762
FL
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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