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NPI Code Detail

MEDICARE: MS. JOSELYN JACKSON

MEDICARE: MS. JOSELYN 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
1224Z00000XOccupational Therapy Assistant209078TX

General Provider Information

NPI Number : 1508019043
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JOSELYN JACKSON
Provider Business Mailing Address
First Line : 8580 WOODWAY DR
Second Line :
City : HOUSTON
State : TX
Zip : 77063-2423
Country : US
Telephone Number : 832-878-0425
Fax Number :
Provider Business Practice Location Address
First Line : 8550 WOODWAY DR
Second Line :
City : HOUSTON
State : TX
Zip : 77063-2482
Country : US
Telephone Number : 713-979-3777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2008
Last Update Date : 02/24/2015

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