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NPI Code Detail

MEDICARE: BRIA JACKSON

MEDICARE: BRIA 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
1224Z00000XOccupational Therapy Assistant15679FL

General Provider Information

NPI Number : 1952868424
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIA JACKSON
Provider Business Mailing Address
First Line : 430 W 34TH ST
Second Line :
City : RIVIERA BEACH
State : FL
Zip : 33404-3010
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 NORTHPOINT PKWY
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33407-7904
Country : US
Telephone Number : 561-712-1717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2019
Last Update Date : 02/20/2019

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Directions to “ BRIA JACKSON ” Practice Location

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