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General NPI Number Information
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NPI Number | 1104427608
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Entity Type | Individual
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Provider Name | JULIE MARIE JACKSON OT
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 7150 GRANITE CIR STE 200
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City | TOLEDO
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State | OH
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Zip | 43617-3114
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Country | US
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Telephone | 419-843-6002
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Fax |
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Provider Business Mailing Address
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Address Line | 319 WOODSIDE TRL
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City | LEBANON
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State | OH
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Zip | 45036-7839
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Country | US
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Telephone | 937-475-8576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 003568
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License Number State | OH
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