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General NPI Number Information
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NPI Number | 1730329384
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Entity Type | Individual
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Provider Name | TIMOTHY LUKE JACKSON
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Gender | Male
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 2085 WAYNE RD
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City | CHAMBERSBURG
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State | PA
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Zip | 17202-8586
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Country | US
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Telephone | 717-261-4137
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Fax |
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Provider Business Mailing Address
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Address Line | 11324 WILLIAMSPORT PIKE
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City | GREENCASTLE
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State | PA
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Zip | 17225-8465
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Country | US
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Telephone |
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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 | OC011017
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License Number State | PA
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