Individual
MRS. JEANETTE MARIE SILVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
705 9TH ST, BOVINA, TX 79009-0093
(575) 693-7510
Mailing address
705 9TH ST, BOVINA, TX 79009
(575) 693-7510
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
211762
TX
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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