Individual
MS. JACQUELINE NICHOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
626 N TYNDALL PKWY, CALLAWAY, FL 32404-6132
(850) 871-6363
Mailing address
626 N TYNDALL PKWY, CALLAWAY, FL 32404-6132
(850) 871-6363
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA15305
FL
Other
Enumeration date
06/12/2018
Last updated
06/12/2018
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