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Individual

MRS. SUE LYON JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LOTA

Contact information

Practice address
1019 HOLDEN ST, GLEN ROSE, TX 76043-4937
(254) 897-2215
(254) 897-2091
Mailing address
1019 HOLDEN ST, GLEN ROSE, TX 76043-4937
(254) 897-2215
(254) 897-2091

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
204760
TX

Other

Enumeration date
08/22/2018
Last updated
08/22/2018
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