Individual
JILLIAN JAN GREGSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
711 S BROADWAY ST, MARLOW, OK 73055-3313
(580) 467-8915
Mailing address
711 S BROADWAY ST, MARLOW, OK 73055-3313
(580) 467-8915
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1447
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447
—
OK
Enumeration date
05/19/2020
Last updated
05/19/2020
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