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Individual

MR. ANDREW JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MOTR/L

Contact information

Practice address
8736 SHADY PINES DR, LAS VEGAS, NV 89143-4460
(435) 650-7128
Mailing address
8736 SHADY PINES DR, LAS VEGAS, NV 89143-4460
(435) 650-7128

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2211
NV
282NR1301X
Rural Acute Care Hospital
10241270-4201
UT

Other

Enumeration date
02/03/2017
Last updated
04/28/2025
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