Individual
STACY JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
216 POPLAR AVE, SUITE 101, SOMERSET, KY 42503-1764
(606) 677-1166
Mailing address
216 POPLAR AVE, SUITE 101, SOMERSET, KY 42503-1764
(606) 677-1166
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
R2703
KY
Other
Enumeration date
01/13/2014
Last updated
01/13/2014
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