Individual
JACKIE HOUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3756 GRACE FALLS DR, ANTIOCH, TN 37013-1576
(615) 426-4235
Mailing address
3756 GRACE FALLS DR, ANTIOCH, TN 37013-1576
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1902
TN
174400000X
Specialist
3130
CO
Other
Enumeration date
03/09/2011
Last updated
03/09/2011
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