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Individual

MRS. IDOLL TINA JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
2650 ELKTON TRL, TYLER, TX 75703-0580
(903) 266-7200
Mailing address
250 W NOTTINGHAM DR STE 200, SAN ANTONIO, TX 78209-1896
(210) 828-5686
(210) 780-6911

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
209095
TX

Other

Enumeration date
09/04/2018
Last updated
09/04/2018
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