Individual
JENNA CORNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOT
Contact information
Practice address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(225) 654-8208
(225) 654-4642
Mailing address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(225) 654-8208
(225) 654-4642
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
308027
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
308027
STATE LICENSE
LA
Enumeration date
01/19/2018
Last updated
01/19/2018
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