Individual
NICOLE DEXTER JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
3001 W BLUE STARR DR, CLAREMORE, OK 74017-2544
(918) 342-5432
Mailing address
14930 E 97TH ST N, OWASSO, OK 74055-4814
(918) 595-0440
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
614
OK
Other
Enumeration date
09/29/2015
Last updated
10/01/2015
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