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General NPI Number Information
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NPI Number | 1245806371
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Entity Type | Individual
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Provider Name | JACLYN MICHELLE STRAM
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Gender | Female
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Dates
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Enumeration Date | 05/30/2021
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Last Update Date | 05/30/2021
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Provider Practice Location Address
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Address Line | 900 IMPERIAL GOLF COURSE BLVD
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City | NAPLES
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State | FL
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Zip | 34110-1085
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Country | US
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Telephone | 239-591-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 235 S LAKE DR
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-7054
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Country | US
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Telephone | 631-796-4115
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 31011
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License Number State | FL
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