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NPI Code Detail

MEDICARE: VALERIE JACKSON OTR/L

MEDICARE: VALERIE JACKSON OTR/L
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
1225X00000XOccupational Therapist2003024194MO
2225XP0200XPediatric Occupational Therapist2015009938MO

General Provider Information

NPI Number : 1821129214
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERIE JACKSON OTR/L
Provider Business Mailing Address
First Line : 3488 JEFFCO BLVD
Second Line : SUITE 102
City : ARNOLD
State : MO
Zip : 63010-6015
Country : US
Telephone Number : 813-476-1674
Fax Number :
Provider Business Practice Location Address
First Line : 3488 JEFFCO BLVD
Second Line : SUITE 102
City : ARNOLD
State : MO
Zip : 63010-6015
Country : US
Telephone Number : 813-476-1674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 06/04/2015

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Directions to “ VALERIE JACKSON OTR/L” Practice Location

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