Individual
DEBRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
13129 ELMDALE ST, DETROIT, MI 48213-1900
(248) 470-5601
Mailing address
13129 ELMDALE ST, DETROIT, MI 48213-1900
(248) 470-5601
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202005307
MI
Other
Enumeration date
12/28/2016
Last updated
12/28/2016
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