Individual
MS. MICHELLE A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0005694
CO
225X00000X
Occupational Therapist
14246
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005694
CO DEPT OF REGULATION
CO
Enumeration date
09/21/2011
Last updated
08/06/2021
Update your record
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