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NPI Code Detail

MEDICARE: SARAH C JACKSON

MEDICARE: SARAH C 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 Therapist1054014201UT

General Provider Information

NPI Number : 1962535534
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH C JACKSON
Provider Business Mailing Address
First Line : PO BOX 711185
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84171-1185
Country : US
Telephone Number : 801-942-3311
Fax Number : 801-942-5955
Provider Business Practice Location Address
First Line : 1952 FORT UNION BLVD STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-6878
Country : US
Telephone Number : 801-942-3311
Fax Number : 801-942-5955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/08/2007

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Directions to “ SARAH C JACKSON ” Practice Location

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