Individual
LISA MICHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR-L
Contact information
Practice address
138 THACHER ST, MILTON, MA 02186-2025
(617) 910-8923
Mailing address
138 THACHER ST, MILTON, MA 02186-2025
(617) 910-8923
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
9925
MA
Other
Enumeration date
04/03/2021
Last updated
04/03/2021
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