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General NPI Number Information
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NPI Number | 1114490786
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Entity Type | Individual
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Provider Name | JACLYN ROSE REESE
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Gender | Female
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 1301 N HIGHLANDS PKWY
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City | TACOMA
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State | WA
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Zip | 98406-2116
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Country | US
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Telephone | 253-752-7112
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Fax |
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Provider Business Mailing Address
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Address Line | 5028 ORVAS CT SE
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City | OLYMPIA
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State | WA
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Zip | 98501-4765
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Country | US
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Telephone | 360-918-6057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.OT.60920648
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License Number State | WA
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