Individual
JACLYN PROVAU ELDRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
235 DUNLOP FARMS BLVD, COLONIAL HEIGHTS, VA 23834-1792
(804) 520-0050
Mailing address
235 DUNLOP FARMS BLVD, COLONIAL HEIGHTS, VA 23834-1792
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005302
VA
Other
Enumeration date
03/23/2011
Last updated
12/15/2014
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