Individual
JESSICA WHEATON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
106 PINETREE DR, FORT MILL, SC 29715-9767
(978) 788-4540
Mailing address
106 PINETREE DR, FORT MILL, SC 29715-9767
(978) 788-4540
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4614
SC
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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