Individual
MR. KEENAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
6301 FOREST HILLS DR NE, ALBUQUERQUE, NM 87109-4137
(505) 823-8399
(505) 823-8324
Mailing address
6301 FOREST HILLS DR NE, ALBUQUERQUE, NM 87109-4137
(505) 823-8399
(505) 823-8324
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3031
NM
Other
Enumeration date
04/01/2013
Last updated
04/01/2013
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