Individual
LEON TREMAINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
601 S SEMORAN BLVD, ORLANDO, FL 32807-3120
(321) 368-2172
Mailing address
12013 ISLAND BAY CIR, SANFORD, FL 32771-6352
(407) 459-6264
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA14670
FL
Other
Enumeration date
07/24/2015
Last updated
07/24/2015
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