Individual
KRISTAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Contact information
Practice address
520 W HURON ST, APT 207, CHICAGO, IL 60654-3432
(804) 814-3104
Mailing address
520 W HURON ST, APT 207, CHICAGO, IL 60654-3432
(804) 814-3104
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056010441
IL
Other
Enumeration date
02/05/2014
Last updated
02/05/2014
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