Individual
NICOLE LEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
241 PARK AVE, SINKING SPRING, PA 19608-1329
(610) 223-7359
Mailing address
241 PARK AVE, SINKING SPRING, PA 19608-1329
(610) 223-7359
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TOP008453
PA
Other
Enumeration date
06/07/2012
Last updated
06/07/2012
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