Individual
JACQUELINE MARIE KLEKOTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4413 GANNON RD, PORTSMOUTH, VA 23703-4830
(757) 735-1478
Mailing address
4413 GANNON RD, PORTSMOUTH, VA 23703-4830
(757) 735-1478
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119004094
VA
Other
Enumeration date
09/08/2008
Last updated
09/08/2008
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