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Individual

MS. LIBERTY ZARIAH JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
2901 FALK RD, VANCOUVER, WA 98661-6392
(360) 313-1250
Mailing address
5718 SW SHATTUCK RD, PORTLAND, OR 97221-1038
(503) 704-7967

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
OT287043
OR
225XP0200X
Pediatric Occupational Therapist
Primary
OT60234654
WA

Other

Enumeration date
09/19/2012
Last updated
09/19/2012
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