Individual
JAMAL OMAR WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 BELMONT AVE, PHILADELPHIA, PA 19131-1648
(215) 878-3600
Mailing address
6636 N BROAD ST, PHILADELPHIA, PA 19126-3222
(267) 270-8490
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TOP009273
PA
Other
Enumeration date
07/12/2019
Last updated
07/12/2019
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