Individual
MRS. JACQUIE KATHLEEN JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
527 MEMORIAL DRIVE, POCATELLO, ID 83201
(208) 478-3333
Mailing address
4913 PLEASANT VIEW DR, CHUBBUCK, ID 83202
(208) 380-3838
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA-1373
ID
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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