Individual
JENNIFFER TACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
768 E LEONA PKWY, LORENA, TX 76655-4207
(254) 747-0574
Mailing address
768 E LEONA PKWY, LORENA, TX 76655-4207
(254) 747-0574
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
212946
TX
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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