Individual
LACY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
810 N CALVERT ST, APT 6, BALTIMORE, MD 21202-3749
(512) 864-5221
Mailing address
810 N CALVERT ST, APT 6, BALTIMORE, MD 21202-3749
(512) 864-5221
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
07487
MD
Other
Enumeration date
12/12/2016
Last updated
12/12/2016
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