Individual
MISS FOUNTALENE LASHAE PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1211 MAIN ST, HARTFORD, KY 42347-1619
(270) 298-5426
(270) 298-5237
Mailing address
1211 MAIN ST, HARTFORD, KY 42347-1619
(270) 298-5426
(270) 298-5237
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A3718
KY
Other
Enumeration date
09/02/2015
Last updated
09/02/2015
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