Individual
LATOYA YVETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10400 S ROBERTS RD, PALOS HILLS, IL 60465-1972
(708) 443-7400
Mailing address
2043 KETTLE CT, LANSING, IL 60438-2552
(708) 663-0114
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005035
IL
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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