Individual
AMANDA FAITH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4201 31ST ST S, ST PETERSBURG, FL 33712-4051
(727) 867-1104
Mailing address
9038 MANORWOOD RD, LAUREL, MD 20723-1390
(301) 821-2644
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT21915
FL
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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