Individual
KASSIDY LYNN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4000 S TULIP TREE DR, PRINCETON, IN 47670-2300
(812) 387-2938
(812) 387-2015
Mailing address
2904 BETSY CT, EVANSVILLE, IN 47720-5913
(812) 431-0718
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
99115773A
IN
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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