Individual
JENNIFER LEA SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
701 S MAIN ST, BROKEN ARROW, OK 74012-5528
(918) 845-8641
Mailing address
2114 W WALNUT ST, COLLINSVILLE, OK 74021-1708
(918) 845-8641
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1419
OK
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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