Individual
BETHANY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
193 FOREST AVE, MIDDLETOWN, RI 02842-4625
(401) 847-2777
Mailing address
77 LUCY AVE, TIVERTON, RI 02878-3921
(401) 575-7067
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA00443
RI
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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