Individual
JODI HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11937 US HIGHWAY 271, TYLER, TX 75708-3154
(903) 877-8700
Mailing address
700 LIVE OAK ST, CANTON, TX 75103-1914
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
118667
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000
NO OTHER IDENTIFIERS
—
Enumeration date
10/22/2019
Last updated
10/22/2019
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