Provider Demographics
NPI:1467874321
Name:JOLETTA K. HENDERSON
Entity Type:Organization
Organization Name:JOLETTA K. HENDERSON
Other - Org Name:EXCEPTIONAL SCHOOL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOLETTA
Authorized Official - Middle Name:KEMP
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-282-7738
Mailing Address - Street 1:6393 GREEN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-7158
Mailing Address - Country:US
Mailing Address - Phone:901-282-7738
Mailing Address - Fax:
Practice Address - Street 1:6393 GREEN GROVE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-7158
Practice Address - Country:US
Practice Address - Phone:901-282-7738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty