Individual
ANTOINETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6909 NORTH AVE, OAK PARK, IL 60302-1008
(708) 386-1112
Mailing address
6909 NORTH AVE, OAK PARK, IL 60302-1008
(708) 386-1112
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057003957
IL
Other
Enumeration date
03/02/2021
Last updated
03/02/2021
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