Individual
MRS. CHRYSTAL MAE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5417 ALTAMESA BLVD, FORT WORTH, TX 76123-2804
(866) 980-2475
Mailing address
640 BENT OAK DR, FORT WORTH, TX 76131-4230
(806) 433-8191
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210256
TX
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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