Individual
JANA RAE CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
IECE
Contact information
Practice address
361 WINDBURN LN, GRAYSON, KY 41143-8372
(606) 475-9564
Mailing address
225 DWIGHT ST, FLATWOODS, KY 41139-9026
(606) 585-3716
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/28/2023
Last updated
05/25/2023
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