Individual
ALICIA J JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
11200 N PORTLAND AVE, OKLAHOMA CITY, OK 73120-5045
(405) 936-1550
(405) 936-1559
Mailing address
508 BRIGHTON DR, EDMOND, OK 73003-3169
(405) 204-0505
(405) 936-1559
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
OCC04318
OK
Other
Enumeration date
06/23/2013
Last updated
06/23/2013
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