Individual
NACOLE MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1120 S CALUMET RD, SUITE 3, CHESTERTON, IN 46304-3285
(219) 983-9675
Mailing address
418 PLANETT ST, LA PORTE, IN 46350-2682
(219) 325-3541
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001281A
IN
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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