Individual
BENJAMIN JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
55 W LAKE RD, PLEASANT HILL, TN 38578-3002
(931) 200-4150
Mailing address
55 W LAKE RD, PLEASANT HILL, TN 38578-3002
(931) 200-4150
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0478
TN
224Z00000X
Occupational Therapy Assistant
1428
TN
Other
Enumeration date
01/29/2019
Last updated
01/29/2019
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