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General NPI Number Information
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NPI Number | 1720326531
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Entity Type | Individual
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Provider Name | ALLANA MICHELLE JACKSON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 4000 CROCKER ROAD
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City | WESTLAKE
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State | OH
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Zip | 44145
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Country | US
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Telephone | 440-250-3015
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Fax |
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Provider Business Mailing Address
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Address Line | 250 VINEYARD RD
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City | AVON LAKE
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State | OH
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Zip | 44012
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Country | US
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Telephone | 904-502-7473
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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 |
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License Number State | OH
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