Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1023147402 |
---|---|
Provider Name | Jeffrey S Jackson |
First Address | Easton, PA 18040-7958 |
Second Address | Riverview, MI 48193-7966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2007 |
Last Update Date | 08/07/2007 |