Individual
AMANDA JAQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5045 VOLUSIA AVE, TITUSVILLE, FL 32780-6829
(484) 577-7291
Mailing address
5045 VOLUSIA AVE, TITUSVILLE, FL 32780-6829
(484) 577-7291
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT18399
FL
Other
Enumeration date
04/14/2017
Last updated
02/01/2023
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