Individual
JAIME JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7003 WOODWAY DR, STE 305, WACO, TX 76712-6170
(254) 776-7864
Mailing address
7035 STEINBECK BEND DR, WACO, TX 76708-5522
(254) 752-0628
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103628
LICENSE #
TX
Enumeration date
08/30/2006
Last updated
07/08/2007
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