Individual
HALEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
12100 W 109TH ST, OVERLAND PARK, KS 66210-1200
(913) 469-4210
Mailing address
529 SOUTHSHORE DR, LAKE WINNEBAGO, MO 64034-7815
(913) 749-7709
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01524
KS
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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