Individual
JEANINE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2471 16TH AVE N, SAINT PETERSBURG, FL 33713-5627
(727) 303-5140
Mailing address
2471 16TH AVE N, SAINT PETERSBURG, FL 33713-5627
(727) 303-5140
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA16397
FL
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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