Individual
MRS. JILL FLEACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
712 W 2ND ST, LEAVENWORTH, IN 47137-2264
(812) 739-2292
Mailing address
9870 N TOBACCO LANDING RD SE, LACONIA, IN 47135-8749
(812) 736-2221
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002040A
IN
Other
Enumeration date
09/30/2011
Last updated
09/30/2011
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