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NPI Code Detail

MEDICARE: TIMOTHY LUKE JACKSON

MEDICARE: TIMOTHY LUKE JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOC011017PA

General Provider Information

NPI Number : 1730329384
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY LUKE JACKSON
Provider Business Mailing Address
First Line : 11324 WILLIAMSPORT PIKE
Second Line :
City : GREENCASTLE
State : PA
Zip : 17225-8465
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2085 WAYNE RD
Second Line :
City : CHAMBERSBURG
State : PA
Zip : 17202-8586
Country : US
Telephone Number : 717-261-4137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2009
Last Update Date : 06/25/2012

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Directions to “ TIMOTHY LUKE JACKSON ” Practice Location

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