Individual
MR. MICHAEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1913 N OAKES ST APT D, TACOMA, WA 98406-7527
(253) 223-3590
Mailing address
1913 N OAKES ST APT D, TACOMA, WA 98406-7527
(253) 223-3590
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC 60534324
WA
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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