Individual
MRS. LESLIE L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, OT/L, FAOTA
Contact information
Practice address
9501 S KING DR, DH 132, CHICAGO, IL 60628-1501
(773) 995-2368
Mailing address
9501 S KING DR, DH 132, CHICAGO, IL 60628-1501
(773) 995-2368
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
056.000012
IL
225XP0200X
Pediatric Occupational Therapist
Primary
056.000012
IL
Other
Enumeration date
06/04/2012
Last updated
06/04/2012
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