Individual
JONATHAN PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
621 DEXTER ST, CENTRAL FALLS, RI 02863-2742
(401) 721-9294
Mailing address
153 SUMMER ST, PROVIDENCE, RI 02903-4011
(401) 276-4347
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA00656
RI
Other
Enumeration date
05/28/2014
Last updated
05/28/2014
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