Individual
COLLEEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
8011 ELKHART AVE, LUBBOCK, TX 79424-2615
(518) 312-7513
Mailing address
6502 SLIDE RD STE 204, LUBBOCK, TX 79424-1311
(806) 686-0429
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
212955
TX
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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