Individual
SARA W. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1201 BROAD ROCK BLVD, PM&R/117, RICHMOND, VA 23249-0001
(804) 675-5000
Mailing address
1201 BROAD ROCK BLVD, PM&R/117, RICHMOND, VA 23249-0001
(804) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119001407
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119001407
COMMONWEALTH OF VIRGINIA DEPT OF HEALTH PROFESSIONS LICENSE NUMBER
VA
01
—
997859
NATIONAL BOARD FOR CERTIFICATION OF OCCUOPATIONAL THERAPY CERTIFICATION NUMBER
—
Enumeration date
06/14/2013
Last updated
06/14/2013
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