Individual
JACKSON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTD, OTR/L
Contact information
Practice address
685 MASSACHUSETTS AVE APT 2, BOSTON, MA 02118-4049
(304) 210-5570
Mailing address
685 MASSACHUSETTS AVE APT 2, BOSTON, MA 02118-4049
(304) 210-5570
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTL14847
MA
Other
Enumeration date
06/06/2023
Last updated
06/06/2023
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