Individual
JOHN PHILLIP JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
7810 AVENUE U APT B, LUBBOCK, TX 79423-2430
(806) 778-9735
Mailing address
7810 AVENUE U APT B, LUBBOCK, TX 79423-2430
(806) 778-9735
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
102473
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8T0844
BLUE CROSS INDIVIDUAL NO
TX
Enumeration date
02/26/2007
Last updated
05/14/2009
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