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Individual

JOHN ALEXANDER JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OTD

Contact information

Practice address
4422 E STATE BLVD, FORT WAYNE, IN 46815-6917
(260) 471-9286
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31007309A
IN

Other

Enumeration date
11/20/2020
Last updated
11/20/2020
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