JACKE KHANTIVONG

DENVER, CO
NPI1619114485
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy225X00000X Occupational Therapist
(Licence: CO  2191)
Additional Taxonomies225X00000X Occupational Therapist
(Licence: CT  003380)
Enumeration Date2009-01-14
Last Update Date2010-08-31
Business Address
Ms. JACKE KHANTIVONG OTR/L
1247 S RACE ST
DENVER, CO 80210-1817
Phone number: 860-306-1384
Mailing Address
Ms. JACKE KHANTIVONG OTR/L
1247 S RACE ST
DENVER, CO 80210-1817
Phone number: 860-306-1384