Individual
AMANDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1760 TURNING LEAF TRL, HAUGHTON, LA 71037-9531
(501) 249-2247
Mailing address
1760 TURNING LEAF TRL, HAUGHTON, LA 71037-9531
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OTR1907
AR
225X00000X
Occupational Therapist
Primary
OTT.200281
LA
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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