Individual
JEANNINE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6715 E 41ST ST, TULSA, OK 74145-4520
(918) 806-0106
Mailing address
622 E MAIN ST, COLLINSVILLE, OK 74021-3616
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
01/14/2021
Last updated
01/14/2021
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