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Individual

DAISY JACOBO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
171 HUNTLEY LN, NOEL, MO 64854-9383
(479) 866-5062
Mailing address
171 HUNTLEY LN, NOEL, MO 64854-9383
(479) 866-5062

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
AR

Other

Enumeration date
03/08/2019
Last updated
03/08/2019
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