Individual
DOUGLENE J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, OTR/L, LMT, ATP
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MA29727
FL
225X00000X
Occupational Therapist
OT003627
GA
225X00000X
Occupational Therapist
Primary
OT10451
FL
247200000X
Other Technician
—
—
Other
Enumeration date
04/06/2007
Last updated
09/06/2019
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