Individual
JACYNDA WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OCCUPATIONAL THERAPI
Contact information
Practice address
815 TRIPLETT ST, OWENSBORO, KY 42303-3564
(270) 683-4517
(270) 852-1491
Mailing address
815 TRIPLETT ST, OWENSBORO, KY 42303-3564
(270) 683-4517
(270) 852-1491
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
R3086
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184517
MEDICARE
KY
05
—
45118379
—
KY
Enumeration date
04/13/2012
Last updated
04/13/2012
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