Individual
JILL LOUISE HAXTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5407 VANCE AVE, FORT WAYNE, IN 46815-6154
(260) 494-8081
Mailing address
5407 VANCE AVE, FORT WAYNE, IN 46815-6154
(260) 494-8081
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31000658A
IN
Other
Enumeration date
07/24/2008
Last updated
10/28/2012
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