Individual
MS. DEBBRA CARLINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3703 W LAKE AVE, SUITE 200, GLENVIEW, IL 60026-5823
(847) 998-1188
(847) 998-8008
Mailing address
3703 W LAKE AVE, SUITE,200, GLENVIEW, IL 60026-5823
(847) 998-1188
(847) 832-2103
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057000216
IL
Other
Enumeration date
04/29/2008
Last updated
04/29/2008
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