Individual
JACKLYN NUCKOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
96 TYREE ST, ANSTED, WV 25812-2581
(304) 658-5271
Mailing address
PO BOX 536, ANSTED, WV 25812-0536
(304) 877-1313
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C2433
WV
Other
Enumeration date
05/11/2023
Last updated
05/11/2023
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