Individual
ALLYSON REVILLA-JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
32011 SUE LN, PINEHURST, TX 77362-4083
(361) 562-4779
Mailing address
32011 SUE LN, PINEHURST, TX 77362-4083
(361) 562-4779
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
219247
TX
Other
Enumeration date
07/27/2026
Last updated
07/27/2026
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