Individual
JACQUELYN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6640 IOLA AVE, LUBBOCK, TX 79424-7845
(806) 786-9995
Mailing address
PO BOX 368, 1809 AVE G, PETERSBURG, TX 79250-0368
(806) 786-9995
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
106908
TX
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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