Individual
AMY S JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
551 W LANCASTER AVE, #400, HAVERFORD, PA 19041-1419
(610) 526-1974
Mailing address
6330 BURBRIDGE ST, APT. B, PHILADELPHIA, PA 19144-2506
(215) 200-3727
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC011075
PA
225X00000X
Occupational Therapist
U1-0001210
DE
Other
Enumeration date
03/08/2011
Last updated
03/08/2011
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