Individual
JESSICA LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
400 E CENTRAL AVE, PONCA CITY, OK 74601-5429
(580) 304-9767
Mailing address
2509 BLUESTEM RD, PONCA CITY, OK 74604-3246
(580) 352-4998
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1470
OK
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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