Individual
MRS. PAMELA DIANNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5400 W 87TH ST, BURBANK, IL 60459-2913
(708) 346-6236
Mailing address
5400 WEST 87TH STREET, BURBANK, IL 60459
(708) 346-6236
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056001722
IL
Other
Enumeration date
10/03/2013
Last updated
10/03/2013
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