Individual
AMANDA LYN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2222 S ROCKPORT RD, BOONVILLE, IN 47601-7926
(812) 629-6260
Mailing address
2222 S ROCKPORT RD, BOONVILLE, IN 47601-7926
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31004809A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31004809A
OCCUPATIONAL THERAPY LICENSE NUMBER
IN
Enumeration date
11/13/2017
Last updated
08/26/2024
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