Individual
JILL KRISTEN LACSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3269 STOCKTON HILL RD, KINGMAN, AZ 86409-3619
(928) 757-2101
Mailing address
2885 N EVANS ST, KINGMAN, AZ 86401-5394
(941) 447-5757
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4647
AZ
Other
Enumeration date
12/31/2015
Last updated
12/31/2015
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