Individual
MR. KEITH R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
600 NORTH BLVD W, SUITE D, LEESBURG, FL 34748-5063
(352) 787-9300
Mailing address
4024 EAGLE RIDGE RD, FRUITLAND PARK, FL 34731-5619
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT9471
FL
Other
Enumeration date
08/23/2007
Last updated
08/23/2007
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