Individual
CASEY NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
15600 SAN PEDRO AVE STE 305, SAN ANTONIO, TX 78232-3739
(210) 582-5840
Mailing address
208 WOODGLENN DR, VICTORIA, TX 77904-1132
(361) 894-4201
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
217958
TX
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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