Individual
JEASICA NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11 PALM AVE, YUKON, OK 73099-5645
(405) 312-4630
Mailing address
2600 COMPASS RD, GLENVIEW, IL 60026-8001
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
841
OK
Other
Enumeration date
04/05/2021
Last updated
04/05/2021
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