Individual
JESSE CASTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
190 MORAVIAN WAY DR, WINSTON SALEM, NC 27106-3216
(366) 767-8130
Mailing address
4650 NC 801 HWY, WOODLEAF, NC 27054-9477
(865) 466-5669
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11987
NC
Other
Enumeration date
11/11/2018
Last updated
11/11/2018
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