Individual
MRS. CHERYL GWENDOLYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
680 S 4TH ST, LOUISVILLE, KY 40202-2407
(502) 596-7640
Mailing address
398 WOODBURY BND, BEECHER, IL 60401-3711
(708) 946-1553
(708) 946-1676
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.004726
IL
Other
Enumeration date
12/11/2012
Last updated
12/11/2012
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