Individual
LINDSEY S JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1200 E 21ST ST, CHEYENNE, WY 82001-3951
(918) 634-7986
Mailing address
900 PONDEROSA RD, CHEYENNE, WY 82009-2502
(307) 634-7986
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1203
WY
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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