Individual
PERIZ MONIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3300 ETHEREDGE DR, AUSTIN, TX 78725-4769
(512) 785-8774
Mailing address
3300 ETHEREDGE DR, AUSTIN, TX 78725-4769
(512) 785-8774
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
209095
TX
Other
Enumeration date
04/08/2008
Last updated
04/08/2008
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