Individual
JERI LYNN ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 TUMBLED STONE WAY, SAINT AUGUSTINE, FL 32086-0226
(217) 417-0088
Mailing address
111 TUMBLED STONE WAY, SAINT AUGUSTINE, FL 32086-0226
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003447
IL
Other
Enumeration date
02/11/2019
Last updated
02/11/2019
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