Individual
MIRANDA L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1360 PORTER ST, DEARBORN, MI 48124-2890
(313) 689-5188
Mailing address
1360 PORTER ST, DEARBORN, MI 48124-2890
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
MI
Other
Enumeration date
04/05/2021
Last updated
09/20/2021
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