Individual
BREIYANNA L JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
8611 LAVENDER RIDGE ST, LAS VEGAS, NV 89131-1101
(702) 406-1149
Mailing address
8611 LAVENDER RIDGE ST, LAS VEGAS, NV 89131-1101
(702) 406-1149
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-227966
NV
224Z00000X
Occupational Therapy Assistant
Primary
OTA-3827
NV
Other
Enumeration date
10/13/2022
Last updated
03/16/2026
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