Individual
MISS MARY RUTH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
68 ALLISON AVE, TAUNTON, MA 02780-6958
(508) 880-0202
Mailing address
68 ALLISON AVE, TAUNTON, MA 02780-6958
(508) 880-0202
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5650
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5650
LICENSE OT MA
MA
Enumeration date
12/22/2007
Last updated
12/22/2007
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