Individual
JENNIFER JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2700 E 34TH ST, JOPLIN, MO 64804-4310
(417) 781-1737
Mailing address
1707 REX AVE APT 161F, JOPLIN, MO 64801-5940
(417) 844-1415
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2015024696
MO
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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