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Individual

JAKE CAVENAUGH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
15 SALEM CHURCH RD, TIFTON, GA 31793-6754
(229) 392-0558
Mailing address
15 SALEM CHURCH RD, TIFTON, GA 31793-6754
(229) 392-0558

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary

Other

Enumeration date
04/08/2014
Last updated
04/08/2014
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