Individual
CAMILLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5199 W OAK GROVE LN, HIGHLAND, UT 84003-9469
(385) 223-0979
Mailing address
5199 W OAK GROVE LN, HIGHLAND, UT 84003-9469
(385) 223-0979
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
10262
NC
224Z00000X
Occupational Therapy Assistant
3509
CA
224Z00000X
Occupational Therapy Assistant
Primary
9082424-4202
UT
Other
Enumeration date
05/09/2016
Last updated
05/09/2016
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