Individual
TARA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPO
Contact information
Practice address
1274 CONGRESS ST, PORTLAND, ME 04102-2111
(207) 774-1002
Mailing address
1274 CONGRESS ST, PORTLAND, ME 04102-2111
(207) 774-1002
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CPO04857
ME
Other
Enumeration date
12/15/2025
Last updated
12/15/2025
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