Individual
MS. DEANA K. JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
2500 MARSHALL AVE, PADUCAH, KY 42003-5529
(270) 554-3135
(270) 554-3136
Mailing address
2500 MARSHALL AVE, PADUCAH, KY 42003-5529
(270) 554-3135
(270) 554-3136
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
R3013
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100112930
—
KY
Enumeration date
10/02/2009
Last updated
02/01/2013
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