Individual
ELIZABETH ANN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
300 E PRAIRIE ST, WARSAW, IN 46580-4429
(260) 578-1380
Mailing address
110 E MAIN STREET, LIBERTY MILLS, IN 46946-0000
(260) 578-1380
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001765A
IN
Other
Enumeration date
09/12/2013
Last updated
09/13/2013
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