MEDICARE: SABRINA 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
1	224Z00000X	Occupational Therapy Assistant	1773	CA

General Provider Information

NPI Number	:	1497141931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA JACKSON

Provider Business Mailing Address
First Line	:	3825 DURFEE AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 DURFEE AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-2505
Country	:	US
Telephone Number	:	800-500-7690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2015
Last Update Date	:	04/11/2015

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