Individual
JOHN PHILLIP JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
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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